Apparatus and systems for minimally invasive dissection of tissues

ABSTRACT

Lysing surgical instruments and related systems and methods. In some embodiments, the instrument may comprise a lysing tip comprising at least one bead. The at least one bead may comprise an at least substantially electrically non-conductive surface and at least one lysing member defining at least one lysing segment extending within a recess defined, at least in part, by the at least one bead. The at least one bead may also protrude both distally and proximally relative to the at least one lysing member.

RELATED APPLICATIONS

This is a continuation of U.S. patent application Ser. No. 16/141,893filed on Sep. 25, 2018 and titled “APPARATUS AND SYSTEMS FOR MINIMALLYINVASIVE DISSECTION OF TISSUES, which claims the benefit under 35 U.S.C.§ 119(e) of U.S. Provisional Patent Application No. 62/563,005 filedSep. 25, 2017 and titled “APPARATUS AND SYSTEMS FOR MINIMALLY INVASIVEDISSECTION OF TISSUES” and is a continuation-in-part of U.S. patentapplication Ser. No. 15/464,199 filed on Mar. 20, 2017 and titled“APPARATUS, SYSTEMS AND METHODS FOR MINIMALLY INVASIVE DISSECTION OFTISSUES,” which claims priority to U.S. Provisional Patent ApplicationNo. 62/313,707, which was filed on Mar. 26, 2016, along with U.S.Provisional Patent Application No. 62/409,575, which was filed on Oct.18, 2016. Each of the aforementioned applications is hereby incorporatedherein by reference.

SUMMARY

-   -   1. A surgical lysing device, comprising:    -   a shaft;    -   a lysing tip positioned at a distal end of the shaft;    -   a first bead positioned at a first end of the lysing tip;    -   a second bead positioned at a second end of the lysing tip        opposite from the first end;    -   a nonconductive strut extending between the first bead and the        second bead, wherein the nonconductive strut is configured to        receive one or more lysing members therein;    -   at least one distal conductive lysing segment between each pair        of adjacent beads of the lysing tip at a distal end of the        lysing tip, wherein the at least one distal conductive lysing        segment is configured to deliver energy to tissue during a        surgical procedure; and    -   at least one proximal conductive lysing segment positioned        within at least one proximal recess, wherein the at least one        proximal conductive lysing segment faces at least generally in a        proximal direction relative to the surgical lysing device, and        wherein the at least one proximal conductive lysing segment is        configured to deliver energy to tissue during a surgical        procedure.    -   2. The surgical lysing device of claim 1, wherein the first bead        and the second bead each comprises a nonconductive material.    -   3. The surgical lysing device of claim 1, wherein the first bead        and the second bead each comprises a conductive core and a        non-conductive shell configured to prevent discharge of energy        along the non-conductive shell.    -   4. The surgical lysing device of claim 1, wherein the        nonconductive strut extends between an inner surface of the        first bead and an inner surface of the second bead.    -   5. The surgical lysing device of claim 1, further comprising a        second nonconductive strut, wherein the nonconductive strut        extends between an inner surface of the first bead and an outer        surface of the shaft, and wherein the second nonconductive strut        extends between an inner surface of the second bead and an outer        surface of the shaft.    -   6. The surgical lysing device of claim 1, wherein the first bead        comprises a tunnel.    -   7. The surgical lysing device of claim 6, wherein the surgical        lysing device comprises a lysing member that extends partially        into the tunnel, and wherein the lysing member defines at least        one lysing segment of the surgical lysing device.    -   8. The surgical lysing device of claim 1, wherein each of the        lysing segments of the surgical lysing device is defined by a        single lysing member.    -   9. The surgical lysing device of claim 1, wherein the first bead        is tilted relative to an axis of the shaft.    -   10. The surgical lysing device of claim 1, wherein the first        bead comprises a distal tip, a proximal tip, and an elongated        axis extending between the distal tip and the proximal tip, and        wherein a proximal portion of the first bead defines a flattened        inner surface that terminates at the proximal tip.    -   11. The surgical lysing device of claim 1, wherein each of the        lysing segments of the surgical lysing device is defined by a        single lysing member.    -   12. The surgical lysing device of claim 11, wherein the lysing        member comprises a non-conductive lip.    -   13. The surgical lysing device of claim 12, wherein the lip        defines a perimeter about a distal portion of the lysing member        having an exposed portion of conductive lysing member within the        perimeter.    -   14. The surgical lysing device of claim 1, further comprising a        temperature sensor positioned on the lysing tip.    -   15. The surgical lysing device of claim 14, wherein the        temperature sensor is positioned on the lysing tip at a position        distal of at least one of the at least one proximal conductive        lysing segment.    -   16. The surgical lysing device of claim 15 wherein the first        bead comprises a distal tip, a proximal tip, and an elongated        axis extending between the distal tip and the proximal tip, and        wherein the temperature sensor is positioned at the distal tip        of at least one of the first bead and the second bead.    -   17. The surgical lysing device of claim 1, further comprising an        oscillating motor unit configured to oscillate the lysing tip at        a frequency of between about 21 kHz and about 40 kHz.    -   18. A surgical lysing device, comprising:    -   a shaft;    -   a lysing tip positioned at a distal end of the shaft;    -   a first bead positioned at a first end of the lysing tip;    -   a second bead positioned at a second end of the lysing tip        opposite from the first end;    -   a nose extending from the shaft in between the first bead and        the second bead, wherein a distal portion of the first bead        defines a first protrusion, wherein a distal portion of the        second bead defines a second protrusion, and wherein the nose        defines a third protrusion;    -   a first strut extending between the first bead and the nose,        wherein the first strut at least in part defines a distal        recession and a proximal recession;    -   a second strut extending between the second bead and the nose,        wherein the second strut at least in part defines a distal        recession and a proximal recession; and    -   at least one electrode defining at least one distal lysing        segment at a distal end of the lysing tip, wherein the at least        one distal conductive lysing segment is configured to deliver        energy to tissue during a surgical procedure, wherein the at        least one electrode further defines at least one proximal lysing        segment at a proximal end of the lysing segment, wherein the at        least one proximal lysing segment is configured to deliver        energy to tissue during a surgical procedure.    -   19. The surgical lysing device of claim 18, wherein the first        bead comprises a tunnel, and wherein at least one electrode is        positioned to partially extend through the tunnel.    -   20. The surgical lysing device of claim 18, wherein the first        bead comprises an elongated axis, and wherein the elongated axis        is tilted relative to an axis of the shaft.    -   21. The surgical lysing device of claim 18, wherein the first        bead comprises an ovoid shape, and wherein the second bead        comprises an ovoid shape.    -   22. The surgical lysing device of claim 21, wherein the nose        defines a partially ovoid shape that at least substantially        matches that of the first bead and the second bead.    -   23. The surgical lysing device of claim 18, wherein the nose is        configured to be received in a slot formed in the shaft.    -   24. The surgical lysing device of claim 18, wherein the at least        one electrode comprises a conductive core defining the first        bead, the second bead, the nose, the first strut, and the second        strut, and wherein the lysing tip further comprises a        non-conductive shell configured to prevent discharge of energy        along the non-conductive shell.    -   25. The surgical lysing device of claim 24, wherein the        non-conductive shell comprises a coating.    -   26. The surgical lysing device of claim 18, wherein the surgical        lysing device comprises a bipolar electrosurgical lysing device,        and wherein at least one electrode comprises a negative        electrode and a positive electrode electrically isolated from        the negative electrode.    -   27. The surgical lysing device of claim 18, further comprising        an oscillating motor unit configured to oscillate the lysing tip        at a frequency of between about 21 kHz and about 40 kHz.    -   28. A method for lysing tissue for a surgical procedure using a        surgical lysing tip, the method comprising the steps of:        -   inserting a lysing tip into a patient through an entrance            wound;        -   advancing the lysing tip to a target tissue;        -   energizing at least one lysing segment of the lysing tip;            and        -   retracting the lysing tip through target tissue to lyse the            target tissue using a retrograde motion towards the entrance            wound.    -   29. The method of claim 28, wherein the step of energizing at        least one lysing segment of the lysing tip comprises energizing        the at least one lysing segment with at least one of ultrasound,        LASER, and electrosurgical energy.    -   30. The method of claim 29, wherein the surgical procedure        comprises blepharoplasty, and wherein the target tissue        comprises orbicularis oculi muscle and dermis.    -   31. The method of claim 29, wherein the surgical procedure        comprises facial dissection, and wherein the target tissue        comprises at least one of dermis, subcutaneous, muscles of        facial expression, and superficial muscular aponeurotic tissue.    -   32. The method of claim 29, wherein the surgical procedure        comprises a neck dissection, and wherein the target tissue        comprises at least one of dermis, subcutaneous, and platysma        muscle.    -   33. The method of claim 29, wherein the surgical procedure        comprises a cellulite dissection, and wherein the target tissue        comprises at least one of dermis, subcutaneous, and fibrotic        elements.    -   34. The method of claim 29, wherein the surgical procedure        comprises an axillary dissection, and wherein the target tissue        comprises at least one of dermis, subcutaneous, sweat glands,        and nerves.    -   35. The method of claim 28, further comprising taking a        temperature measurement from the lysing tip during the step of        retracting the lysing tip through target tissue to lyse the        target tissue.    -   36. The method of claim 35, wherein the temperature measurement        is taken at a location distal of the target tissue during the        retrograde motion.    -   37. The method of claim 36, wherein the lysing tip comprises at        least one proximal-facing lysing segment, wherein the lysing tip        comprises a temperature sensor, and wherein the temperature        sensor is positioned on the lysing tip at a location distal of        the at least one proximal-facing lysing segment.    -   38. An electrosurgical lysing device, comprising:        -   a lysing tip configured for delivery of electrosurgical            energy, the lysing tip comprising a first bead positioned at            a first end of the lysing tip and a second bead positioned            at a second end of the lysing tip opposite from the first            end;        -   a lysing member defining at least one lysing segment between            the first bead and the second bead, wherein the lysing            member is configured to deliver electrosurgical energy to            tissue during a surgical procedure;        -   a grasping member coupled to the lysing member and extending            at an at least substantially perpendicular angle relative to            the lysing member, wherein the grasping member comprises a            terminus configured to be engaged by at least one jaw of an            electrosurgical instrument configured to deliver            electrosurgical energy through the grasping member and into            the lysing member, and wherein each of the first bead and            the second bead comprises a hole extending from the            respective bead to the lysing member.    -   39. The electrosurgical lysing device of claim 38, wherein each        of the first bead and the second bead comprises a hole extending        from a rear surface of the respective bead to the lysing member.    -   40. The electrosurgical lysing device of claim 38, wherein each        of the first bead and the second bead comprises a flattened rear        surface.    -   41. The electrosurgical lysing device of claim 40, wherein each        of the first bead and the second bead comprises a narrowed        distal surface opposite the flattened rear surface.    -   42. The electrosurgical lysing device of claim 38, wherein the        lysing member comprises a first end portion at a first end of        the lysing member, a second end portion at a second end of the        lysing member opposite from the first end, and a central portion        in between the first end portion and the second end portion,        wherein the first end portion has a greater diameter than the        central portion, and wherein the second end portion has a        greater diameter than the central portion.    -   43. The electrosurgical lysing device of claim 42, wherein the        first end portion comprises a first spheroid, and wherein the        second end portion comprises a second spheroid.    -   44. The electrosurgical lysing device of claim 43, wherein the        first and second spheroids are configured to allow the first and        second beads to rotate with respect to the lysing member.    -   45. The electrosurgical lysing device of claim 43, wherein each        of the first and second beads further comprises a tunnel        intersecting the hole, and wherein the tunnel extends along an        axis of the lysing member and is configured to receive the        lysing member therein.    -   46. The electrosurgical lysing device of claim 45, wherein the        tunnel comprises a diameter less than a diameter of the hole,        wherein the tunnel comprises a diameter less than a diameter of        the first spheroid, and wherein the hole comprises a diameter at        least as large as the diameter of the first spheroid such that        the first spheroid can rotate within the hole but cannot exit        the tunnel.    -   47. The electrosurgical lysing device of claim 38, wherein the        grasping member comprises a grasping rod, and wherein the        grasping rod comprises a grasping rod axis extending at least        substantially perpendicular to a lysing member axis of the        lysing member.    -   48. The electrosurgical lysing device of claim 47, wherein the        grasping rod axis is configured to be at least substantially        aligned with an axis of the electrosurgical instrument when the        grasping member is engaged by the at least one jaw of the        electrosurgical instrument.    -   49. The electrosurgical lysing device of claim 38, wherein the        terminus is positioned at a proximal end of the grasping member,        and wherein the terminus is configured to be received in a slot        formed in the at least one jaw of the electrosurgical        instrument.    -   50. The electrosurgical lysing device of claim 49, wherein the        terminus comprises a conductive terminus configured to deliver        electrosurgical energy from the electrosurgical instrument.    -   51. The electrosurgical lysing device of claim 49, wherein the        terminus comprises a hemisphere shape.    -   52. The electrosurgical lysing device of claim 38, wherein the        lysing tip further comprises at least one bead positioned        between the first bead and the second bead.    -   53. An electrosurgical system comprising:        -   an electrosurgical lysing tip configured for delivery of            electrosurgical energy, the lysing tip comprising:            -   a first bead positioned at a first end of the lysing tip                and a second bead positioned at a second end of the                lysing tip opposite from the first end;            -   a lysing member defining at least one lysing segment                between the first bead and the second bead, wherein the                lysing member is configured to deliver electrosurgical                energy to tissue during a surgical procedure; and an                electrosurgical instrument comprising at least one jaw                configured to engage the electrosurgical lysing tip and                deliver electrosurgical energy into the lysing member,                wherein the at least one jaw comprises an insulating jaw                cover positioned over a conductive jaw core.    -   54. The electrosurgical system of claim 53, wherein the        electrosurgical lysing tip further comprises a grasping member,        and wherein the electrosurgical instrument is configured to        engage the grasping member and deliver electrosurgical energy        into the lysing member through the grasping member.    -   55. The electrosurgical system of claim 54, wherein the        insulating jaw cover comprises an opening configured to allow        for delivery of electrosurgical energy from the conductive jaw        core through the grasping member and into the lysing member.    -   56. The electrosurgical system of claim 55, wherein the grasping        member comprises a terminus formed at a proximal end of the        grasping member, and wherein the opening is configured to        receive and engage the terminus.    -   57. The electrosurgical system of claim 56, wherein the at least        one jaw further comprises a slot extending from the opening, and        wherein the slot is configured to receive the grasping member.    -   58. The electrosurgical system of claim 57, wherein the slot        extends at least substantially along an axis of the        electrosurgical instrument.    -   59. The electrosurgical system of claim 53, further comprising        an insulating sheath configured to be removably positioned over        a shaft of the electrosurgical instrument.    -   60. The electrosurgical system of claim 59, wherein the        insulating jaw cover comprises at least one rib extending along        an exterior surface of the insulating jaw cover, and wherein the        at least one rib is configured to engage the insulating sheath        to couple the insulating sheath to the shaft at a predetermined        axial location along the shaft.    -   61. The electrosurgical system of claim 60, wherein the at least        one rib is configured to provide a fluid seal against the        insulating sheath.    -   62. The electrosurgical system of claim 53, wherein the        insulating jaw cover comprises a coupling opening configured to        facilitate affixation of the insulating jaw cover to the        conductive jaw core.    -   63. The electrosurgical system of claim 62, wherein the coupling        opening comprises a weld hole, and wherein the insulating jaw        cover is welded to the conductive jaw core through the weld        hole.    -   64. The electrosurgical system of claim 53, wherein the        insulating jaw cover comprises a slot configured to receive and        engage at least a portion of the electrosurgical lysing tip        therein.    -   65. The electrosurgical system of claim 64, wherein the slot is        configured to receive and engage the lysing member therein.    -   66. The electrosurgical system of claim 64, wherein the slot        extends at least substantially perpendicular to an axis of the        electrosurgical instrument.    -   67. The electrosurgical system of claim 66, wherein the        insulating jaw cover comprises an opening configured to allow        for delivery of electrosurgical energy from the conductive jaw        core into the lysing member.    -   68. The electrosurgical system of claim 67, wherein the opening        is positioned within the slot.    -   69. The electrosurgical system of claim 68, wherein the opening        is configured such that at least a portion of the conductive jaw        core protrudes through the opening to allow for contact between        the conductive jaw core and the lysing member.    -   70. The electrosurgical system of claim 53, wherein the        electrosurgical lysing tip further comprises a grasping loop        configured to allow a grasping instrument to temporarily hold        the electrosurgical lysing tip in place while the at least one        jaw of the electrosurgical instrument engages the        electrosurgical lysing tip.    -   71. The electrosurgical system of claim 70, wherein the grasping        loop is made up of a bioresorbable material.    -   72. The electrosurgical system of claim 53, wherein the        electrosurgical instrument is configured to directly engage the        lysing member.    -   73. The electrosurgical system of claim 72, wherein the        electrosurgical instrument comprises a tip configured to at        least substantially mimic the shape and function of a bead when        the lysing member is engaged by the electrosurgical instrument.    -   74. The electrosurgical system of claim 53, wherein the        electrosurgical lysing tip further comprises at least one bead        positioned in between the first bead and the second bead.    -   75. An electrosurgical instrument, comprising:        -   a grasping tip comprising at least one jaw configured to be            selectively repositioned between an open configuration and a            closed configuration, wherein, in the closed configuration,            the grasping tip is configured to engage a lysing tip, and            wherein the grasping tip is configured to deliver            electrosurgical energy into the lysing tip during a surgical            procedure;        -   a shaft extending from the grasping tip; and        -   a handle extending from the shaft, wherein a lower surface            of the handle is positioned above a plane defined by the            shaft.    -   76. The electrosurgical instrument of claim 37, wherein the        handle is configured such that no portion of the lower surface        of the handle extends below the plane defined by the shaft.    -   The electrosurgical instrument of claim 76, wherein the handle        is configured to allow a user's fingers to grasp the handle        along the lower surface from above the plane defined by the        shaft during use.    -   77. The electrosurgical instrument of claim 75, wherein the        electrosurgical instrument is configured to allow a user to        grasp and operate the electrosurgical instrument by grasping a        portion of the handle extending at least substantially parallel        to the shaft.    -   78. The electrosurgical instrument of claim 75, wherein the        handle comprises:        -   at least one electrosurgical actuation switch; and        -   at least one grasping tip actuator configured to selectively            open and close the at least one jaw.    -   79. The electrosurgical instrument of claim 75, wherein the        electrosurgical instrument is configured such that no portion of        the electrosurgical instrument extends from the shaft at an        angle perpendicular or substantially perpendicular to the shaft.    -   80. An electrosurgical lysing tip, comprising:        -   a first bead positioned at a first end of the lysing tip;        -   a tuberous terminus positioned at a second end of the lysing            tip opposite from the first end, wherein the tuberous            terminus is configured to be received in and engaged by at            least one jaw of an electrosurgical instrument;        -   a second bead positioned in between the first bead and the            tuberous terminus; and        -   a lysing member defining at least one lysing segment between            each pair of adjacent beads of the electrosurgical lysing            tip, wherein the lysing member is configured to deliver            electrosurgical energy to tissue during a surgical            procedure.    -   81. The electrosurgical lysing tip of claim 80, wherein the        tuberous terminus comprises a spheroid.    -   82. The electrosurgical lysing tip of claim 80, wherein the        bulbous terminus is configured to allow the electrosurgical        lysing member to be rotated while the bulbous terminus is        received in the at least one jaw of the electrosurgical        instrument.    -   83. The electrosurgical lysing tip of claim 82, wherein the        lysing member comprises a lysing plate.    -   84. An electrosurgical lysing system, comprising:        -   an electrosurgical lysing tip, comprising:            -   a first bead positioned at a first end of the                electrosurgical lysing tip;            -   a tuber; and            -   a lysing member defining at least one lysing segment                along the electrosurgical lysing tip, wherein the lysing                member is configured to deliver electrosurgical energy                to tissue during a surgical procedure; and an                electrosurgical instrument, comprising:            -   a tip comprising at least one jaw configured to engage                the electrosurgical lysing tip, wherein the tuber is                configured to be received in and engaged by the at least                one jaw of the electrosurgical instrument, wherein the                at least one jaw comprises a receiving slot configured                to receive and engage the tuber.    -   85. The electrosurgical lysing system of claim 84, wherein the        tuber comprises a tuberous terminus.    -   86. The electrosurgical lysing system of claim 85, wherein the        tuberous terminus is positioned at a second end of the        electrosurgical lysing tip opposite from the first end.    -   87. The electrosurgical lysing system of claim 86, further        comprising a second bead positioned in between the first bead        and the tuberous terminus.    -   88. The electrosurgical lysing system of claim 84, wherein the        lysing member defines a lysing segment between the tuber and an        adjacent bead.    -   89. The electrosurgical lysing system of claim 88, wherein the        tip is configured to at least substantially mimic the shape and        function of a bead.    -   90. The electrosurgical lysing system of claim 84, wherein the        receiving slot comprises a treatment locking portion configured        to receive the lysing member and a tuber portion configured to        receive the tuber therein.    -   91. The electrosurgical lysing system of claim 90, wherein the        tuber comprises a tuberous terminus, and wherein the tuber        portion comprises a rotational portion configured to        rotationally engage the tuberous terminus to allow for rotation        of the electrosurgical lysing tip between a delivery        configuration and a treatment configuration.    -   92. The electrosurgical lysing system of claim 84, wherein the        at least one jaw further comprises an insulating jaw cover        extending over a conductive jaw core.    -   93. An electrosurgical system comprising:        -   an electrosurgical lysing tip configured for delivery of            electrosurgical energy, the lysing tip comprising:            -   a first bead;            -   a second bead; and            -   a lysing plate defining at least one lysing segment                between the first bead and the second bead, wherein the                lysing plate is configured to deliver electrosurgical                energy to tissue during a surgical procedure, and                wherein the lysing plate comprises a protruding member;                and an electrosurgical instrument comprising at least                one jaw configured to engage the protruding member and                deliver electrosurgical energy into the lysing plate                through the protruding member.    -   94. The electrosurgical lysing system of claim 93, wherein the        protruding member comprises a protruding conductive hemisphere.    -   95. The electrosurgical lysing system of claim 93, wherein the        protruding member extends from an upper surface of the lysing        plate.    -   96. The electrosurgical lysing system of claim 93, wherein the        at least one jaw comprises a grasping channel configured to        receive and engage the lysing plate.    -   97. The electrosurgical lysing system of claim 96, wherein the        at least one jaw further comprises an electrosurgical energy        transfer opening, wherein the electrosurgical energy transfer        opening is positioned within the grasping channel, and wherein        the protruding member is configured to extend through the        electrosurgical energy transfer opening to allow for contact        with a conductive portion of the at least one jaw.    -   98. The electrosurgical lysing system of claim 97, wherein the        at least one jaw comprises an insulating jaw cover positioned        over a conductive jaw core, wherein the grasping channel and the        electrosurgical energy transfer opening are formed in the        insulating jaw cover, and wherein the protruding member is        configured to extend through the electrosurgical energy transfer        opening to allow for contact with the conductive jaw core.    -   99. The electrosurgical lysing system of claim 93, wherein the        lysing plate comprises a beveled leading edge.    -   100. The electrosurgical lysing system of claim 93, wherein the        first bead is positioned at a first end of the lysing tip, and        wherein the second bead is positioned at a second end of the        lysing tip opposite from the first end.    -   101. The electrosurgical lysing system of claim 93, wherein each        of the first bead and the second bead comprises a hole extending        to the lysing plate, and wherein each of the first bead and the        second bead is coupled to the lysing plate through the hole.    -   102. The electrosurgical lysing system of claim 101, wherein the        hole comprises a weld hole, and wherein a metallic object is        welded to the lysing plate through the weld hole.    -   103. A system for delivery of tissue modification energy during        a surgical procedure, comprising:        -   a tissue modification tip, the tissue modification tip            comprising:            -   an energy window configured to deliver energy                therethrough for modification of tissue during a                surgical procedure; and            -   a bulbous terminus positioned at a first end of the                tissue modification tip; and        -   an energy delivery instrument comprising at least one jaw            configured to engage the bulbous terminus to facilitate            operation of the tissue modification tip during the surgical            procedure, and wherein the energy delivery instrument is            configured to deliver energy into the energy window.    -   104. The system of claim 67, wherein the energy delivery        instrument is configured to deliver energy into the energy        window through the bulbous terminus.    -   105. The system of claim 67, wherein the energy delivery        instrument is configured to deliver electrosurgical energy into        the energy window.    -   106. The system of claim 67, wherein the tissue modification tip        further comprises an energy delivery conduit, and wherein the        energy delivery instrument is configured to deliver energy into        the energy window through the energy delivery conduit.    -   107. The system of claim 106, wherein the energy delivery        conduit is positioned on the bulbous terminus.    -   108. The system of claim 107, wherein the energy delivery        instrument further comprises an energy delivery conduit, and        wherein the energy delivery conduit of the tissue modification        tip is configured to engage the energy delivery conduit of the        energy delivery conduit of the energy delivery instrument upon        coupling the tissue modification tip with the energy delivery        instrument.    -   109. The system of claim 103, wherein the energy window        comprises an elongated energy window.    -   110. The system of claim 103, wherein the tissue modification        tip further comprises a non-conductive cover comprising an        opening through which a conductive portion of the tissue        modification tip defining the energy window extends.    -   111. The system of claim 110, wherein the tissue modification        tip further comprises a conductive core configured to be        received in the non-conductive cover, and wherein the conductive        core comprises a flattened region adjacent to the bulbous        terminus.    -   112. The system of claim 111, wherein the at least one jaw        comprises a receiving slot configured to receive and engage the        tissue modification tip therein.    -   113. The system of claim 112, wherein the receiving slot        comprises a flattened groove configured to receive and engage        the flattened region of the conductive core.    -   114. The system of claim 113, wherein the receiving slot further        comprises a rotational portion configured to receive the bulbous        terminus, and wherein the rotational portion is configured to        allow the tissue modification tip to be rotated while within the        at least one jaw between a delivery configuration and a        treatment configuration.    -   115. The system of claim 113, wherein the flattened region        comprises a treatment locking portion configured to lock the        tissue modification tip in position during treatment in a        position in which an elongated axis of the tissue modification        tip extends at least substantially perpendicular to an elongated        axis of the energy delivery instrument.    -   116. The system of claim 103, wherein the energy delivery        instrument is configured to deliver at least one of laser,        intense pulse light, resistive heating, radiant heat,        thermochromic, ultrasound, and microwave energy.    -   117. A surgical device for delivery of tissue modification        energy during a surgical procedure, comprising:        -   a tissue modification tip comprising an elongated axis and            an energy window configured to deliver energy therethrough            for modification of tissue during a surgical procedure,            wherein the energy window comprises a plurality of spaced            apart electrode termini; and        -   a shaft configured to house the tissue modification tip in            an axial configuration wherein the elongated axis is at            least substantially aligned with an axis of the shaft,            wherein the tissue modification tip is configured to be            deployed from the axial configuration to a treatment            configuration in which the tissue modification tip extends            at an angle relative to the axis of the shaft.    -   118. An electrosurgical instrument, comprising:        -   a tip configured to deliver electrosurgical energy            therethrough;        -   a shaft coupled with the tip, wherein the shaft comprises a            shaft axis; and        -   means for pressing a lysing tip towards a desired treatment            tissue in a direction at least substantially normal to the            shaft axis.    -   119. The electrosurgical instrument of claim 118, wherein the        lysing tip is removably couplable with the tip.    -   120. The electrosurgical instrument of claim 118, further        comprising a non-conductive sheath configured to be positioned        over at least a portion of the shaft axis.    -   121. The electrosurgical instrument of claim 120, wherein the        means for pressing a lysing tip towards a desired treatment        tissue is positioned on an exterior surface of the        non-conductive sheath.    -   122. The electrosurgical instrument of claim 120, wherein the        means for pressing a lysing tip towards a desired treatment        tissue comprises at least one inflatable segment positioned on        an exterior surface of the non-conductive sheath.    -   123. The electrosurgical instrument of claim 122, wherein the at        least one inflatable segment comprises a plurality of inflatable        segments.    -   124. The electrosurgical instrument of claim 123, wherein each        of the plurality of inflatable segments is spaced apart from an        adjacent inflatable segment and is positioned on an exterior        surface of a first side of the non-conductive sheath and not on        a second side of the non-conductive sheath opposite the first        side.    -   125. The electrosurgical instrument of claim 118, wherein the        means for pressing a lysing tip towards a desired treatment        tissue is positioned on an exterior surface of a first side of        the shaft and not on a second side of the shaft opposite the        first side.    -   126. The electrosurgical instrument of claim 118, wherein the        means for pressing a lysing tip towards a desired treatment        tissue comprises at least one of at least one inflatable segment        and a mechanical lift assembly.    -   127. The electrosurgical instrument of claim 118, wherein the        means for pressing a lysing tip towards a desired treatment        tissue comprises at least one deflection leg positioned along        the shaft.    -   128. The electrosurgical instrument of claim 127, wherein the at        least one deflection leg is configured to deploy by bowing        outward from one side of the shaft to deflect the instrument        towards an opposite side of the shaft.    -   129. An electrosurgical lysing tip comprising:        -   a first bead positioned at a first end of the            electrosurgical lysing tip;        -   a second bead positioned at a second end of the            electrosurgical lysing tip opposite from the first end;        -   a lysing rod defining at least one lysing segment between            the first bead and the second bead, wherein the lysing rod            is configured to deliver electrosurgical energy to tissue            during a surgical procedure upon being coupled with an            electrosurgical instrument; and        -   a grasping tab coupled with the lysing rod, wherein the            grasping tab is configured to be engaged by at least one jaw            of a surgical instrument.    -   130. The electrosurgical lysing tip of claim 129, wherein the        grasping tab is bioresorbable.    -   131. The electrosurgical lysing tip of claim 129, wherein a        portion of the grasping tab used to couple the grasping tab with        the lysing rod is configured to degrade upon being exposed to        electrosurgical energy from the electrosurgical instrument.    -   132. An electrosurgical lysing tip, comprising:        -   a first bead positioned at a first end of the lysing tip;        -   a second bead positioned at a second end of the            electrosurgical lysing tip opposite from the first end;        -   a nonconductive lysing member body extending between the            first bead and the second bead, wherein the nonconductive            lysing member body is configured to receive one or more            lysing members therein;        -   and        -   at least one conductive lysing member defining at least one            conductive lysing segment between each pair of adjacent            beads of the electrosurgical lysing tip, wherein the at            least one conductive lysing member is configured to deliver            electrosurgical energy to tissue during a surgical            procedure.    -   133. The electrosurgical lysing tip of claim 132, wherein the at        least one conductive lysing member comprises a first conductive        lysing member and a second lysing member, and wherein the first        conductive lysing member is electrically isolated from the        second conductive lysing member within the nonconductive lysing        member body.    -   134. The electrosurgical lysing tip of claim 133, wherein the        electrosurgical lysing tip comprises a bipolar electrosurgical        lysing tip configured for delivery of bipolar electrosurgical        energy therethrough.    -   135. The electrosurgical lysing tip of claim 134, wherein the        first conductive lysing member comprises a first terminal post        configured for delivery of electrosurgical energy therethrough,        and wherein the second conductive lysing member comprises a        second terminal post configured for delivery of electrosurgical        energy therethrough.    -   136. The electrosurgical lysing tip of claim 135, wherein the        first terminal post is configured to contact a first jaw of an        electrosurgical instrument when the electrosurgical lysing tip        is coupled with the electrosurgical instrument, and wherein the        second terminal jaw is configured to contact a second jaw of the        electrosurgical instrument opposite from the first jaw when the        electrosurgical lysing tip is coupled with the electrosurgical        instrument.    -   137. The electrosurgical lysing tip of claim 136, wherein the        first terminal post is configured to extend through a first        opening formed in a first side of the nonconductive lysing        member body, and wherein the second terminal post is configured        to extend through a second opening formed in a second side of        the nonconductive lysing member body opposite from the first        side.    -   138. The electrosurgical lysing tip of claim 132, wherein the        nonconductive lysing member body comprises a grasping pad        configured to engage at least one jaw of an electrosurgical        instrument.    -   139. The electrosurgical lysing tip of claim 138, wherein the        grasping pad is at least substantially centrally positioned        along an elongated axis of the electrosurgical lysing tip, and        wherein the grasping pad comprises a lower profile relative to        adjacent regions of the nonconductive lysing member body in a        direction at least substantially opposite from the elongated        axis.    -   140. The electrosurgical lysing tip of claim 139, wherein the        grasping pad at least partially defines a pair of opposing wings        of the nonconductive lysing member body.    -   141. An electrosurgical system comprising:        -   a bipolar electrosurgical lysing tip configured for delivery            of electrosurgical energy, the lysing tip comprising:            -   a first bead;            -   a second bead;            -   a nonconductive lysing member body; and            -   at least one pair of electrically isolated lysing                members extending between the first bead and the second                bead, wherein the at least one pair of electrically                isolated lysing members is configured to deliver bipolar                electrosurgical energy to tissue during a surgical                procedure; and        -   an electrosurgical instrument comprising a pair of jaws            configured to engage the nonconductive lysing member body            and deliver electrosurgical energy into the at least one            pair of electrically isolated lysing members through the            pair of jaws.    -   142. The electrosurgical lysing system of claim 141, wherein the        pair of jaws comprises an insulating jaw cover positioned over a        conductive jaw core.    -   143. The electrosurgical system of claim 142, wherein the        insulating jaw cover comprises a first opening configured to        allow for delivery of electrosurgical energy from the conductive        jaw core to a first lysing member of the at least one pair of        electrically isolated lysing members, and a second opening        configured to allow for delivery of electrosurgical energy from        the conductive jaw core to a second lysing member of the at        least one pair of electrically isolated lysing members.    -   144. The electrosurgical system of claim 143, wherein the first        lysing member comprises a first terminal post, and wherein the        second lysing member comprises a second terminal post.    -   145. The electrosurgical system of claim 144, wherein the first        terminal post is configured to contact a first jaw of an        electrosurgical instrument when the electrosurgical lysing tip        is coupled with the electrosurgical instrument, and wherein the        second terminal jaw is configured to contact a second jaw of the        electrosurgical instrument opposite from the first jaw when the        electrosurgical lysing tip is coupled with the electrosurgical        instrument.    -   146. The electrosurgical lysing system of claim 145, wherein the        first terminal post is configured to extend through the first        opening, and wherein the second terminal post is configured to        extend through the second opening.

The features, structures, steps, or characteristics disclosed herein inconnection with one embodiment may be combined in any suitable manner inone or more alternative embodiments.

The term dissection may indicate the separation of tissues or of onetissue plane from another (ref: Free Online Medical Dictionary). Somealso consider dissection to comprise separation of a single tissue intoportions. Much of the bodies of animals and humans are formed fromembryonic fusion planes. Many of the organs of the human or animal bodymay be categorized from the embryonic fusion planes from whence theycame. The interfaces between organs may often be referred to as ‘tissueplanes.’ Such planes may be considered substantially planar dependingupon the size of a comparative planar living or inanimate object (suchas a surgical instrument). Some embodiments disclosed herein maycomprise cannula-delivered tissue dissectors (CDTD). Other embodimentsdisclosed herein may be used without a cannula and may therefore beconsidered non-cannula-delivered tissue dissectors (non-CDTD). Someembodiments may be used either with or without cannulas and therefore,depending upon the systems/procedure, may be considered CDTD ornon-CDTD. Both the CDTD and non-CDTD embodiments disclosed herein mayperform the functions of sharp dissection, blunt dissection,electrosurgical cutting and/or coagulation simultaneously without asurgeon having to switch instruments. Tissue modification may also becarried out.

Sharp dissection has been referred to by some as separation of tissuesby means of the sharp edge of a knife or scalpel or with the inner sharpedge of scissors. Blunt dissection has been defined by Webster assurgical separation of tissue layers by means of an instrument without acutting edge or by the fingers.

The term ‘minimally invasive surgery’ has been used to describe aprocedure (surgical or otherwise) that is less invasive than opensurgery used for the same purpose. Some minimally invasive procedurestypically involve use of laparoscopic and/or endoscopic devices andmanual and/or remote/computerized manipulation of instruments withindirect observation of the surgical field through an endoscope orsimilar device, and are carried out through the skin or through a bodycavity or anatomical opening. This may result in shorter hospital stays,or allow outpatient treatment (reference: Wikipedia).

Sometimes minimally invasive surgery is known as “keyhole” surgery andmay be performed using one or more trocars and one or more laparoscopesand/or endoscopes and/or cannulae to access tissues within the body.

The term ‘open surgery’ is used to indicate cutting skin and tissues to‘open the body’ so that the surgeon has direct access to the structuresor organs involved. An incision may of the size that permits a surgeon'shands to enter the patient's body. The structures and tissues involvedmay be seen and touched and may be directly exposed to the air of theoperating room.

The term “cannula,” as used herein, is intended to encompass any tube ortubular structure that is configured to be inserted into the body of ahuman or animal during a surgical procedure and facilitate selectivemovement of a surgical device and/or related components for performingdelivery of the surgical device and/or surgical procedures with thesurgical device. Tubular structures that contain fixedstructures/elements therein, such as needle drivers or graspinginstruments, are not considered cannulas as that term is used herein.Although often “trocars” are used in connection with cannulas, the termcannula, as used herein, is intended to encompass a trocar alone if sucha trocar is capable of being used to insert a medical device into abody.

It may be advantageous to have a spot coagulator extend from anembodiment of the CDTD at such a distance and/or location that allowscomplete viewing and/or contact of a bleeding area with a portion of thespot coagulator (for example the distal end point of a tip of thecoagulator). Such a probe may be deployable and may obtain electricalenergy off of a conductive element located between the lysing elementsof the tip and the plug.

BRIEF DESCRIPTION OF THE DRAWINGS

The written disclosure herein describes illustrative embodiments thatare non-limiting and non-exhaustive. Reference is made to certain ofsuch illustrative embodiments that are depicted in the figures, inwhich:

FIG. 1 a is a side view of a bead of the embodiment shown in FIG. 1 r.

FIG. 1 b is a back perspective view of a bead of the embodiment shown inFIG. 1 r.

FIG. 1 c is a cross sectional side view of the embodiment previouslydepicted in FIG. 1 b at the location shown in FIG. 1 b.

FIG. 1 d is a perspective view of the lysing rod assembly.

FIG. 1 e is an upper view of lysing tip of the embodiment shown in FIG.1 r.

FIG. 1 f is side perspective view of the lysing tip of the embodimentshown in FIG. 1 r.

FIG. 1 g is upper cross sectional view of the lysing tip coupled to thelower jaw assembly of the embodiment shown in FIG. 1 r.

FIG. 1 h is a side view of the lysing tip and distal portion of thegrasping/control instrument of the embodiment shown in FIG. 1 r.

FIG. 1 i is an upper view of the lysing tip and distal portion of thegrasping/control instrument with the upper jaw removed of the embodimentshown in FIG. 1 r.

FIG. 1 j is a perspective view of the distal tip of the grasping/controlinstrument with transparent jaw coverings exposing the jaw tongues ofthe embodiment shown in FIG. 1 r.

FIG. 1 k is a side view of the distal tip of the grasping/controlinstrument with transparent jaw coverings exposing the jaw tongues ofthe grasping/control instrument of the embodiment shown in FIG. 1 r.

FIG. 1L is perspective view of an upper jaw covering of thegrasping/control instrument of the embodiment shown in FIG. 1 r.

FIG. 1 m is a perspective view of an upper jaw armature and jaw tongueof the grasping/control instrument of the embodiment shown in FIG. 1 r.

FIG. 1 n is a perspective view of a lower jaw covering of thegrasping/control instrument of the embodiment shown in FIG. 1 r.

FIG. 1 o is a perspective view of a lower jaw armature and jaw tongue ofthe grasping/control instrument of the embodiment shown in FIG. 1 r.

FIG. 1 p is a cross sectional side view of the grasping/controlinstrument and lysing tip of the embodiment shown in FIG. 1 r.

FIG. 1 q is a perspective view of the distal end of the embodiment shownin FIG. 1 r with part of upper jaw assembly removed to expose seating oflysing tip.

FIG. 1 r is a perspective view of an embodiment of a system for deliveryof a lysing tip in a treatment configuration with jaws closed.

FIG. 1 s is a perspective view of an embodiment of a system for deliveryof a lysing tip in a treatment configuration with jaws open.

FIG. 1 t is a side view of a handle assembly.

FIG. 1 u is a perspective view of another style of handle assembly withshaft and jaws.

FIG. 1 v is a cross sectional side view of the embodiment shown in FIG.1 u.

FIG. 2 a is a perspective view of an embodiment of a system for deliveryof a lysing tip in a treatment configuration.

FIG. 2 b is a perspective view of the lysing tip of the embodiment shownin FIG. 2 a.

FIG. 2 c is an upper view of the lysing tip of the embodiment shown inFIG. 2 a.

FIG. 2 d is a perspective view of the distal tip of the grasping/controlinstrument with upper jaw components removed and lysing tip with onebead removed of the embodiment shown in FIG. 2 a.

FIG. 2 e is a perspective view of the lower jaw assembly of theembodiment shown in FIG. 2 a.

FIG. 2 f is an upper view of the distal end of the embodiment shown inFIG. 2 a with sleeve retracted exposing armature.

FIG. 2 g is an upper view of the distal end of the embodiment shown inFIG. 2 a with sleeve covering armature.

FIG. 2 h is a cross sectional side view of the grasping/controlinstrument and lysing tip of the embodiment shown in FIG. 2 a.

FIG. 2 i is a perspective view of a lower jaw covering of the embodimentshown in FIG. 2 a.

FIG. 2 j is a perspective view of the lower jaw and tongue of theembodiment shown in FIG. 2 a.

FIG. 2 k is a perspective view of the distal end of the embodiment shownin FIG. 2 a with jaws open.

FIG. 2L is a perspective view of the lower jaw covering exposing theelectrosurgical energy transfer opening of the embodiment shown in FIG.2 a.

FIG. 2 m is an upper view of a lysing tip with a loop.

FIG. 3 a is an upper view of lysing tip of the embodiment of FIG. 3 d.

FIG. 3 b is an upper perspective view of the distal tip of theembodiment depicted in FIG. 3 d in the treatment configuration.

FIG. 3 c is a perspective view of the embodiment previously depicted inFIG. 3 a in the delivery configuration.

FIG. 3 d is a perspective view of an embodiment of a system for deliveryof a lysing tip in a treatment configuration.

FIG. 3 e is a perspective view of the embodiment depicted in FIG. 3 d inthe delivery configuration.

FIG. 3 f is a perspective view of the upper jaw covering of theembodiment depicted in FIG. 3 d.

FIG. 3 g is a perspective view of the lower jaw covering of theembodiment depicted in FIG. 3 d

FIG. 3 h is an upper view of additional features that may be added tolysing tip of the embodiment depicted in FIG. 3 d

FIG. 3 i is a side perspective view of a bead of the embodiment depictedin FIG. 3 d

FIG. 4 a is a perspective view of an embodiment of a system for deliveryof a lysing tip in a treatment configuration with sleeve positioneddistally.

FIG. 4 b is a perspective view of the embodiment previously depicted inFIG. 4 a with sleeve positioned proximally exposing armature and withjaw open.

FIG. 4 c is an upper view of the lysing tip of the embodiment depictedin FIG. 4 a.

FIG. 4 d is a front view of the embodiment depicted in FIG. 4 a.

FIG. 4 e is a perspective view of the lysing tip of the embodimentpreviously depicted in FIG. 4 a.

FIG. 4 f is a lower perspective view of the lysing member of theembodiment previously depicted in FIG. 4 a.

FIG. 4 g is a side view of the bead of the embodiment previouslydepicted in FIG. 4 a.

FIG. 4 h is a view of the other side of the bead depicted in FIG. 4 g.

FIG. 4 i is a cross sectional view of the distal end of thegrasping/control instrument of the embodiment depicted in FIG. 4 a.

FIG. 4 j is a perspective view of a lower jaw covering of the embodimentdepicted in FIG. 4 a.

FIG. 5 a is a perspective view of an embodiment of a system for deliveryof an energy window in the treatment configuration with sleevepositioned distally.

FIG. 5 b is a perspective view of the embodiment depicted in FIG. 5 a inthe delivery configuration.

FIG. 5 c is a side cross sectional view of the grasping/controlinstrument of the embodiment depicted in FIG. 5 a.

FIG. 5 d is an upper view of the TMT of the embodiment depicted in FIG.5 a.

FIG. 5 e is a front view of the TMT of the embodiment depicted in FIG. 5a.

FIG. 5 f is a perspective view of the cover of the embodiment depictedin FIG. 5 a.

FIG. 5 g is a perspective view of the energy window of the embodimentdepicted in FIG. 5 a.

FIG. 5 h is a perspective view of the lower jaw covering of theembodiment depicted in FIG. 5 a.

FIG. 6 a is perspective view of a sleeve with inflatable segments.

FIG. 6 b is a front view of the sleeve depicted in FIG. 6 a.

FIG. 7 a comprises a perspective view of a lysing member/lysing rod witha circular cross-section.

FIG. 7 b comprises a perspective view of a lysing member/lysing rod witha triangular cross-section.

FIG. 7 c comprises a perspective view of a lysing member/lysing rod witha rectangular cross-section.

FIG. 7 d comprises a perspective view of a lysing member/lysing rod witha pentagonal cross-section.

FIG. 7 dx comprises a perspective view of a lysing member/lysing rodhaving a pentagonal cross section that is twisted along its length.

FIG. 7 e comprises a perspective view of a lysing member/lysing rod witha hexagonal cross-section.

FIG. 7 f comprises a perspective view of a lysing member/lysing rod witha wedge cross-section.

FIG. 7 g comprises a perspective view of a lysing member/lysing rod witha half-circle cross-section.

FIG. 7 h comprises a perspective view of a spacer to a lysing tip with ahole through its length having a circular cross-section with non-beveledends.

FIG. 7 i comprises a perspective view of a spacer to a lysing tip with ahole through its length having a circular cross-section with beveledends.

FIG. 7 j comprises a perspective view of a spacer to a lysing tip with ahole through its length having a circular cross-section with beveledends and holes.

FIG. 7 k comprises a perspective view of a spacer to a lysing tip with ahole through its length having a circular cross-section arced along itslength.

FIG. 7L comprises a perspective view of a spacer to a lysing tip withopposing loops connected by a rod in a relaxed state.

FIG. 7 m comprises a perspective view of a spacer to a lysing tip withopposing loops connected by a rod in a stressed state.

FIG. 7 n comprises a perspective view of a spacer to a lysing tip with ahole through its length having a triangular cross-section.

FIG. 7 o comprises a perspective view of a spacer to a lysing tip with ahole through its length having a rectangular cross-section.

FIG. 7 p comprises a perspective view of a spacer to a lysing tip with ahole through its length having a pentagonal cross-section.

FIG. 7 px comprises a perspective view of a spacer to a lysing tip witha hole through its length having a pentagonal cross section that istwisted along its length.

FIG. 7 q comprises a perspective view of a spacer to a lysing tip with ahole through its length having a hexagonal cross-section.

FIG. 7 r comprises a perspective view of a spacer to a lysing tip with ahole through its length having a blade-shaped cross-section with roundededges.

FIG. 7 s comprises a perspective view of a spacer to a lysing tip with ahole through its length having a blade-shaped cross-section with flatedges.

FIG. 7 t comprises a perspective view of a spacer to a lysing tip with ahole through its length having a spindle cross-section.

FIG. 7 aa is a perspective view of a bead having a spherical shape.

FIG. 7 bb is a perspective view of a bead having a wheel shape.

FIG. 7 cc is a perspective view of a bead having a dodecahedron shape.

FIG. 7 dd is a perspective view of a bead having a substantiallyellipsoidal shape.

FIG. 7 ee is a perspective view of a bead having a substantiallyellipsoidal shape with facets.

FIG. 7 ff is a perspective view of a bead having a substantiallyellipsoidal shape able to accept a sleeve.

FIG. 7 gg is a perspective view of a bead having a partially ellipsoidalshape with a flat proximal end and facets.

FIG. 7 hh is a perspective view of a bead having a partially ellipsoidalshape with two flat surfaces on its proximal end.

FIG. 7 ii is an upper view of a bead having a partially ellipsoidal withconvex proximal end.

FIG. 7 jj is an upper view of a bead having a partially ellipsoidalshape with an asymmetric proximal end with facets.

FIG. 7 kk is an upper view of a bead having a partially ellipsoidalshape with an angular cut-out on its proximal end.

FIG. 7LL is an upper view of a bead having a partially ellipsoidal shapewith a concave proximal end.

FIG. 7 mm is a side view, from the outside, of an outer bead having asubstantially annular shape.

FIG. 7 nn is a side view, from the inside, of bead depicted in FIG. 7mm.

FIG. 70 o is a side view of a deformable bead having a substantiallyannular shape.

FIG. 7 pp is a side view of a middle bead having a substantially annularshape and knobs on its proximal end.

FIG. 7 qq is a side view of a middle bead having a substantially annularshape and a cross-member at its proximal end.

FIG. 7 rr is a side perspective view of a bead comprising a slotconfigured to engage a lysing member.

FIG. 7 ss is a side perspective view of a set of 3 beads with the sameleading curved distal and proximal shapes, however, each of a differinglength.

FIG. 7 tt is a side perspective view of a set of 3 beads with the sameleading flattened distal and proximal shapes, however, each of adiffering length.

FIG. 7 uu is a side perspective view of a set of 4 beads with the samecurved shape, however, each of a differing length.

FIG. 7 vv is a side perspective view of a set of 4 beads with the samecurved shapes, however, each of a differing length.

FIG. 7 ww is a side perspective view of a set of 4 beads with aflattened shape, however, each of a differing length.

FIG. 7 xx is a side perspective view of a set of 4 beads with the samecurved shape, however, each of a differing length.

FIG. 7 yy is a side perspective view of a set of 4 beads with the samecurved shape, however, each of a differing length.

FIG. 7 zz is a perspective view of a bead with surface irregularities.

FIG. 7 zzz is a perspective view of a bead with surface regularities.

FIG. 8 a is a partial breakaway view of the delivery of lysing tip andgrasping/control instrument inside a body, said lysing tip to bereceived and held by a second instrument until the grasping/controlinstrument grasps and controls lysing tip for the surgical procedure.

FIG. 8 b is a perspective view of the interaction between a lysing tip,its grasping/control instrument, and a temporary holding/graspinginstrument.

FIG. 8 c is a view of the abdomen depicting the construction of asurgical device to be used therein.

FIG. 8 d is a top plan view of a modular lysing tip depicting internalcomponents of a locking mechanism.

FIG. 9 a is a perspective view of an embodiment of a system for deliveryof a bipolar lysing tip in the treatment configuration with sleevepositioned distally.

FIG. 9 b is a perspective view of the embodiment depicted in FIG. 9 awith jaw open and sleeve positioned proximally.

FIG. 9 c is a front view of the embodiment depicted in FIG. 9 a.

FIG. 9 d is an upper view of the lysing tip coupled with jaws of theembodiment depicted in FIG. 9 a.

FIG. 9 e is a perspective view of the bipolar lysing tip of theembodiment depicted in FIG. 9 a.

FIG. 9 f is a perspective view of an electrode of the lysing tip of theembodiment depicted in FIG. 9 a.

FIG. 9 g is a perspective view of the opposing electrode to thatdepicted in FIG. 9 f.

FIG. 9 h is a perspective view of the bipolar lysing tip of theembodiment depicted in FIG. 9 a with cross member being transparentexposing lysing segments and seated in lower jaw with upper jaw removed.

FIG. 9 i is a perspective view of the bipolar lysing tip of theembodiment depicted in FIG. 9 a with upper jaw removed and cross memberseated in lower jaw showing exposure of lysing segment post.

FIG. 9 j is a cross sectional view of the distal end of the embodimentdepicted in FIG. 9 a at the location shown in FIG. 9 c.

FIG. 9 k is a cross sectional view of the distal end of the embodimentdepicted in FIG. 9 a at the location shown in FIG. 9 c.

FIG. 9L is a perspective view of a bottom cover of the embodimentdepicted in FIG. 9 a.

FIG. 10 a is a top plan view of a 2-bead lysing instrument.

FIG. 10 b is a top plan view of the embodiment depicted in FIG. 10 a.

FIG. 10 c is a perspective view of the embodiment depicted in FIG. 10 a.

FIG. 10 d is a top view of the electrode of the embodiment depicted inFIG. 10 a.

FIG. 10 e is a perspective view of the nonconductive body of theembodiment depicted in FIG. 10 a.

FIG. 10 f is a side elevation view of the lysing tip of the embodimentdepicted in FIG. 10 a.

FIG. 10 g is a cross-sectional view of bottom half of the embodimentdepicted in FIG. 10 a taken along line 10 g-10 g of FIG. 10 f.

FIG. 10 h is a perspective view of the nonconductive body of analternative embodiment.

FIG. 10 i is a side elevation view of the lysing tip of the alternativeembodiment depicted in FIG. 10 h.

FIG. 10 j is a cross-sectional view of the bottom half of the embodimentdepicted in FIG. 10 h taken along line 10 j-10 j in FIG. 10 i with anelectrode inserted within the nonconductive body.

FIG. 10 k is a cross-sectional view taken along line 10 k-10 k of FIG.10 i of the bottom half of an alternative embodiment with a modifiedelectrode tip.

FIG. 10L is a perspective view of the modified electrode of thealternative embodiment depicted in FIG. 10 k.

FIG. 11 a is a perspective view of a 3-bead lysing instrument accordingto some embodiments.

FIG. 11 b is a perspective view of the lysing tip of the embodimentdepicted in FIG. 11 a.

FIG. 11 c is an exploded view of the lysing tip of the embodimentdepicted in FIG. 11 a.

FIG. 11 d is a side elevation view of the lysing tip of the embodimentdepicted in FIG. 11 a.

FIG. 11 e is a cross-sectional view of the lysing tip of the embodimentdepicted in FIG. 11 a taken along line 11 e-11 e in FIG. 11 d.

FIG. 11 f is a perspective view of an alternative embodiment of a lysingtip.

FIG. 11 g is a side elevation view of an additional alternativeembodiment of a lysing tip comprising beads lacking a tunnel.

FIG. 11 h is a cross-sectional view of the embodiment of FIG. 11 g takenalong line 11 h-11 h in FIG. 11 g.

FIG. 11 i is a side elevation view of an additional alternativeembodiment of a lysing tip wherein the beads of the lysing tip aretilted relative to the axis of the instrument shaft.

FIG. 12 is a perspective view of a 2-bead lysing tip comprising acoated, unibody conductor according to other embodiments.

FIG. 13 a is a perspective view of a 3-bead lysing tip comprising acoated, unibody conductor according to other embodiments.

FIG. 13 b is a top plan view of the embodiment depicted in FIG. 13 a.

FIG. 13 c is a cross-sectional view taken along line 13 c-13 c in FIG.13 b.

FIG. 14 a is a side elevation view of an embodiment of a lysinginstrument comprising a deflection system.

FIG. 14 b is a perspective view of the distal end of the lysinginstrument depicted in FIG. 14 a.

FIG. 14 c is a front elevation view of the embodiment depicted in FIG.14 a.

FIG. 14 d is a perspective view of the deflector sleeve of theembodiment depicted in FIG. 14 a.

FIG. 15 a is a perspective view of an embodiment of a bipolar lysinginstrument.

FIG. 15 b is a top plan view of the lysing tip of the embodiment of FIG.15 a.

FIG. 15 c is a side elevation view of the embodiment of FIG. 15 a.

FIG. 15 d is a cross-sectional view taken along line 15 d-15 d in FIG.15 c.

FIG. 16 a is a perspective view of a tissue modification instrument inits treatment configuration.

FIG. 16 b is a perspective view of the embodiment depicted in FIG. 16 ain an intermediate configuration.

FIG. 16 c is a perspective view of the embodiment depicted in FIG. 16 ain an additional intermediate configuration.

FIG. 16 d is a is a perspective view of the embodiment depicted in FIG.16 a in its fully retracted configuration.

FIG. 16 e is a cut away view of the distal end of the embodiment in FIG.16 a in its fully retracted configuration.

FIG. 16 f is an exploded view of the embodiment depicted in FIG. 16 a.

FIG. 17 a is a perspective view of alternative embodiment of a lysingtip.

FIG. 17 b is a top plan view of the embodiment depicted in FIG. 17 a.

FIG. 17 c is a side elevation view of an alternative embodiment of alysing tip wherein the beads adjacent to the nose of the lysinginstrument comprise openings adjacent the lysing segment/electrode.

FIG. 17 d is a perspective view of the embodiment depicted in FIG. 17 c.

FIG. 17 e is a cross-sectional view taken along line 17 e-17 e in FIG.17 c.

FIG. 18 a is a perspective view of an alternative embodiment of a lysingtip.

FIG. 18 b is a top plan view of the embodiment depicted in FIG. 18 a.

FIG. 19 a is a perspective view of an alternative embodiment of a lysingtip.

FIG. 19 b is a top plan view of the embodiment depicted in FIG. 19 a.

FIG. 20 a is a perspective view of an alternative embodiment of a lysingtip.

FIG. 20 b is a top plan view of the embodiment depicted in FIG. 20 a.

FIG. 21 a is a perspective view another alternative embodiment of alysing tip.

FIG. 21 b is a side elevation view of the embodiment depicted in FIG. 21a.

FIG. 21 c is a cross-sectional view taken along line 21 c-21 c in FIG.21 b.

DETAILED DESCRIPTION

Further details regarding various embodiments will now be provided withreference to the drawings.

FIGS. 1 a-1 v depict an embodiment of a CDTD (Cannula Delivered TissueDissector) or non-CDTD system 100. System 100 comprises a plurality ofprotrusions 101 defined by beads 151 and jaw covers 193 aa/194 aa andrecessions 102 positioned in between adjacent beads 151 and jaw covers193 aa/194 aa. System 100 comprises a lysing tip 110 that is configuredto be completely separable from any other element of the system,however, lysing tip 110 may be configured to work in conjunction withthe distal end of jaw assemblies 193/194 of grasping/control instrument190, as the rigid grasping member 161 may provide a desirable spacingbetween the lysing tip 110 and the distal ends of the jaw.

Lysing tip 110 may comprise two beads 151 a/151 b positioned at oppositeend of lysing member 160. In alternative embodiments, beads 151 a/b maybe replaced with beads of any shape, including but not limited to thosedepicted in FIGS. 7 aa to 7 zzz. Beads 151 may be comprised of facets152. In the depicted embodiment, lysing member 160 may be permanently ortemporarily coupled to a rigid and/or substantially rigid graspingmember 161 as shown in FIGS. 1 d, 1 e, 1 f, 1 g, and 1 i . In thedepicted embodiment, grasping member 161 comprises a grasping wire.However, other embodiments are contemplated in which grasping member maycomprise, for example, a flattened grasping member, such as a graspingplate. As also depicted in the figures, grasping member 161 extends atright angle with respect to lysing member 160, although this need not bethe case in alternative embodiments. In some embodiments, one or both ofjaws 193/194 may comprise a slot 197 configured to receive the rigidgrasping member/wire 161. Slot 197 may be configured so as to tightlyreceive rigid grasping wire 161 so as to prevent or at least inhibitrotation of lysing tip 110. Alternatively, slot 197 may either beslightly larger than the diameter of rigid grasping wire 161 or may beconfigured to allow a user to adjust the size of slot 197 by actuatingone or both of jaw assemblies 193/194 such that the user can provide fora desired amount of rotation corresponding with the force delivered tojaw assemblies 193/194. In other embodiments, the grasping member/wire161 may have a non-circular cross-section and the slot 197 may have asimilar non-circular cross-section so as to inhibit rotation. Otherfeatures may be included to limit or selectively allow for rotation ofthe lysing tip 110 by inhibiting the rotation of rigid lysing wire 161,such as welds and/or modifications to the terminus of grasping wire 161such as welded/metallic terminus 161 a. For example, in someembodiments, terminus 161 a may shaped as a spheroid, ellipsoid, orother geometric shape, which may be enlarged with respect to graspingmember/wire 161 (in the depicted embodiment, terminus 161 a comprises aconductive-metal hemisphere). In some embodiments, terminus 161 a may beconfigured to be received in a terminal portion of slot 197, such asopening 187, which may keep tip 110 in a fixed position with respect toinstrument 190. As described below, in some embodiments, opening 187 mayalso comprise a conduit to allow for delivery of electrosurgical energyfrom instrument 190 to lysing member 160 of tip 110. In some suchembodiments, terminus 161 a may protrude through opening 187 to allowfor direct contact with a conductive portion of instrument 190, such astongue 194 a′.

In other contemplated embodiments, spacers may be positioned adjacent toopposing outer beads 151 a/b such that the rigid grasping wire 161 mayintersect the lysing member/rod between two spacers (not shown) and suchthat spacers are positioned between each two adjacent beads, asdescribed below in connection with an alternative embodiment in FIG. 2 .Such spacers may be used to either inhibit or selectively limit rotationby, for example, their shape, and/or proximity to the intersectionpoint. In alternative embodiments, spacers may be replaced with spacersof any shape, including but not limited to those depicted in FIGS. 7 h-7t . This alternative embodiment may be applied to other embodimentsherein.

In this embodiment, beads 151 a/b may rotate about lysing rod 160, thus,a surgeon may be able to dissect on one or more of the sides of thedissection plane on the backstroke, possibly making surgery moreefficient via dissecting in the reverse direction. In some embodiments,beads 151 a/b may be configured to rotate about lysing rod 160 such thatthe distal ends of the beads become the proximal ends when the motion ofthe lysing tip is reversed. However, in other embodiments, the rotationmay be limited to another predetermined range of motion.

In the depicted embodiment, a moveable sheath 195 external to thegrasping control device 190 may reduce electrosurgical discharge bypreventing upper and lower conductive jaw armature 193 a/194 a frombeing exposed to bodily fluids, charred material, and debris. Themoveable sheath 195 is usually present along a substantial length of theshaft 190 a of the grasping control instrument 190. Sheath 195 may becomprised of plastic, silicone, ceramic, cermet, halogenatedhydrocarbon, and/or other nonconductive materials. Sheath 195 may bedisposable facilitating cleaning of the instrument and replacement ofsheath. Prior to use, sheath 195 may be slid into a position to exposethe metal armature of the jaw assemblies to facilitate cleaning. Duringdelivery and use, sheath 195 may be slid distally until the distal endof sheath 195 contacts the most distal rib of ribs 189 b of jawcoverings 193 aa/194 aa. Upper and lower jaw coverings 193 aa and 194 aamay be nonconductive and specially shaped with one or more ribs 189a/189 b ridges, and/or surface features so as to prevent outer sheath195 overlying shaft 190 a from sliding to an unwanted position. Sheathand ribs as well, when suitably positioned, may form a seal to preventunwanted electrical discharge. In some embodiments, ribs 189 a/189 b mayalso provide the surgeon with a physical end point to the extension ofsheath 195.

While the grasping/control instrument 190 is energized withelectrosurgical energy, beads 151 a/151 b and upper and lower jawcoverings 193 aa and 194 aa are preferably non-conductive, thusminimizing unwanted electrical discharge. Each upper and lower jawassembly 193/194 respectively, may be comprised of upper and lower jaws193 a/194 a (that may be conductive and/or metallic) and upper and lowerjaw coverings 193 aa/194 aa, respectively. Upper and lower jaws 193a/194 a may comprise corresponding distal jaw tongues 193 a′/194 a′. Theinside of one or both non-conductive jaw coverings 193 aa and 194 aa maybe formed with one or more receiving chambers 188 a and 188 brespectively, to receive their corresponding conductive tongues 193 a′or 194 a′. The electrically conductive tongues 193 a′ and/or 194 a′ mayhave an area adjacent to opening 187 in one or more of the nonconductivejaw coverings 193 aa/194 aa in order to permit electrosurgical energyflow to from one or more electro-conductive tongues to the terminus 161a of rigid grasping wire 161. In some embodiments, a portion of tongues194 a′ and/or 193 a′ may be configured to protrude into opening 187 tofurther facilitate such energy transfer, possibly instead of protrudingterminus 161 a. However, in the depicted embodiment, tongues 194 a′and/or 193 a′ may be relatively flat in this region. Nonconductive jawcoverings 193 aa/194 aa may be comprised of ceramic, cermet, glass,various halogenated hydrocarbons, and any other suitable nonconductors.Nonconductive jaw coverings 193 aa/194 aa may be restricted in theirmotion and/or affixed to conductive tongues 193 a′/194 a′ via one ormore cover welds placed in cover weld holes 193 c/194 c, said welds maybe affixed to each tongue thus restricting movement of the correspondingjaw covering. When an electrosurgical generator is activated by asurgeon, electrosurgical energy may be transmitted through the metalpushrod 190 p, through linkage 190L, and through upper and/or lower jaws193 a/194 a coupled to jaw tongues 193 a′/194 a′. The pivot points alongthe electrical path may be coupled in ways commonly known in the art,for example, via pins.

Jaw assemblies 193/194 may be comprised of single action or doubleaction jaws that may, but need not, open more than 10 to 15 degreesrelative to one another in order to accept/capture the terminus 161 a ofrigid grasping wire 161. This reduced range of motion may reduce damageto ceramic coverings 193 aa/194 aa.

Lysing tip 110 may be configured to prevent or limit lateral movement ofouter beads 151 a/b by joining metallic spheroid 160 a via weld 160 w tolysing rod 160 within bead rod tunnels 154 and corresponding bead holes155 intersect. In some embodiments, other objects may be welded or gluedto effectively couple the beads 151 a/151 b to lysing rod 160. In thedepicted embodiment, metallic bulbs 160 a, such as ball bearings orother spheroids, may be passed down hole 155 and welded to the ends oflysing rod 160 at bead weld 160 w. This may allow for rotationalmovement of beads around the lysing rod 160. Any suitable weldingtechnique may be used, however, resistance welding may be preferred. Inthe depicted embodiment, beads 151 are about 4 mm in length, tunnel 154is about 0.55 mm in diameter containing lysing rod 160 about 0.5 mm indiameter, and/or bead hole 155 is about 0.8 mm in diameter which cancapacitate the transport and welding of an about 0.7 mm metallicspheroids 160 a. The diameter of metallic spheroids 160 a is preferablysmaller than hole 155, but larger than tunnel 154 so bulbs/spheroids 160a can be inserted through tunnel 154 and, once welded, metallicspheroids 160 a prevent the lysing rod 161 from being withdrawnthrough/from tunnel 154. In some embodiments, other geometric shapes maybe used that prevent the lysing rod 161 from being withdrawnthrough/from tunnel 154. The spheroidal shape of a ball bearing orsubstantially spheroidal shape of a polyhedron may still allow forrotation of beads 151 a/b provided the tunnel sizes and weld sizespermit. Alternatively, other shapes and/or sizes of bulbs may be used toinhibits, or limit, rotation of corresponding beads as desired.

In alternative embodiments, the dimensions of lysing rod 160 may bemodified to approach the width and/or thickness of previously describedlysing plates, as described in U.S. patent application Ser. No.15/464,199 titled “Apparatus, Systems, and Methods for MinimallyInvasive Dissection of Tissues”, which is hereby incorporated herein byreference in its entirety. Additionally, in alternative embodiments, therigid grasping wire 161 may be modified in width and in thickness toresemble a plate. The terminus 161 a may also be modified so as torequire a corresponding recession in the upper jaw in order to allowproper occlusion of the jaws.

In some embodiments, the exposed regions of rigid grasping wire 161 maybe overlaid with an insulating coating, such as a ceramic, cermet,glass, halogenated hydrocarbon, diamond-like carbon coating, plastic,epoxy, or the like. In the depicted embodiment, however, rather than acoating, one or more exposed regions of rigid grasping wire 161 may becovered with a non-conductive object 161 c that may be comprised ofceramics, cermets, and glass, and may be shaped as spheroids, cylinders,and/or capsule shapes. Such a dielectric object 161 c on the exposedarea of the rigid grasping wire 161 may, among others, facilitate smoothtissue movement of the lysing tip and reduce tissue trauma whilereducing unwanted electrical discharge. Non-conductive objects, such asobject 161 c, may be preferred over mere coatings due to enhancedability to inhibit undesired transfer of electrosurgical energy and maybe applied by sliding such objects in place over the grasping wire 161.

While traditional non-conductive coatings of metallic parts may beapplied to the distal grasper's jaws and armature, such coatings may notbe as effective at preventing electrical discharge after a certainnumber of uses and/or cleaning cycles. Using ceramics and/or more robustnon-conductive materials to make the jaw coverings may allow for agreater number of cleaning cycles thus providing more cost value tosurgeons and/or patients.

Beads 151, or any of the other beads described herein, are preferablymade from a suitable inert, biocompatible, and non-conductive material,for example, such as a suitable plastic, alumina, zirconia, siliconnitride, silicon carbide, glass, graphite, silicate, diamond,carbon-containing compounds, cermet, or ceramic material or the like, ora combination of one or more of the foregoing.

In the depicted embodiment, lysing rod/member 160 is positioned throughbeads 151 at a location such that beads 151 may be non-symmetricaland/or eccentric relative to tunnels 154. In other words, as best shownin FIG. 1 c , tunnels 154 more be positioned to extend through anon-central location within beads 151. Moreover, in the depictedembodiment, beads 151 are non-symmetrical relative to an axis extendingthrough the side-to-side centers of beads 151 (perpendicular to the longaxis of the beads). In addition, as shown in the figures, thedistal/forward tip of beads 151 may have a more narrowed end to act moreas a wedge for purposes of acting as a blunt dissector between tissuesand tissue planes; the proximal/non-distal/back portions being lessnarrowed and/or larger in volume may create a desirable drag effect thusorienting the bead in a desirable direction for dissection. Whereas therear/proximal end of beads 151 may take many shapes that may be largerand/or more prominent than that of the front/distal end of the beads. Asin FIG. 1 a , the forward tip may be narrowed by use of facets 152;three are visible and numbered and the fourth is on the opposite side ofthe one facing the reader. As described later in FIGS. 7 aa-zzz, a widevariety of alternative bead shapes are possible including, for example,ovoid shapes, spherical shapes, wheel shapes, bullet shapes or othershapes having a flat terminal end (such as, for example, frusto-shaped),wing shapes, etc. As can be seen from some of the examples shown inFIGS. 7 aa-zzz, in some embodiments, beads may be symmetrical relativeto the openings for receiving the rod. In some embodiments, beads 151may be faceted on the top, bottom, sides, front and/or back. Facets arepreferably formed on the distal/front/leading portions of the bead tofacilitate tip movement through/between tissue layers.

In some embodiments, the tunnels 154 may be positioned in a non-centrallocation within beads 151. For example, in some preferred embodiments,the tunnels 154 may be positioned in a forward or distal locationrelative to a central axis of beads 151. This may be preferable to allowthe lysing tip 110 to be directed through tissue in a desired manner,such as without allowing the beads 151 to rotate on their respectivetunnels in an undue manner. However, some embodiments may be configuredto allow a certain amount of such rotation so that the tip can bemaneuvered through patient tissue in a flexible manner.

In some alternative embodiments, the forward or distal portions 101 ofbeads relative to tunnels 154 may also, or alternatively, be wider thansuch that beads 151 have a trailing end that may be longer and/or morenarrow, which may yield desired aerodynamics and/or maneuverability;this may be similar to a ‘kite-tail’ effect.

Preferably, the entire surface of the beads may be smooth, however, somefaceting features may provide for a surface that is less smooth. Forexample, providing a smooth front end and a smooth trailing end mayallow the lysing tip to be moved in a forward direction and then in arearward direction back and forth without catching an undesirable amountof tissue on beads to inhibit such movement. However, as mentionedelsewhere in this disclosure, in some embodiments, the trailing end maycomprise a flat surface such that the entire bead comprises afrusto-ellipsoidal shape or another similar shape. Preferably, at leastthe forward or distal surface of the beads is smooth and defines anellipsoidal shape or another shape having an at least substantiallysmooth forward surface. In alternative embodiments, various portions ofthe bead may be textured or given surface irregularities that may yielda desired dissection orientation such as for example having thenon-proximal/rear portion of the bead roughened on the surface to createdrag from the rear.

In some embodiments, it may be desirable to allow beads 151 to rotate onlysing rod 160. Thus, beads 151 may not be fixed three-dimensionallywith respect to lysing rod 160 and/or one or more other elements oflysing tip 110. In some such embodiments, beads 151 may be at leastpartially rotatable with respect to the entire lysing tip 110. Forexample, the beads may rotate about the rod upon encountering tissuesimilar to that of a vegetable/fruit peeler. In embodiments in whichbeads 151 are rotatable in this manner, it may be desirable to use alysing rod having a circular cross section. Other embodiments arecontemplated in which, instead of being rotatable, the beads may beotherwise movable with respect to one or more elements of a lysing tip110. In any such embodiments, such beads may be considered notthree-dimensionally fixed with respect to the lysing rod and/or lysingtip.

Each bead may comprise hole 155 that may be positioned perpendicular tolysing rod hole 154; holes 155 may be available as a platform/locationto add other features/components such as providing a location forcoupling of a cord as described below in connection with otherembodiments and/or locating a sensor and/or RFID location componentand/or being used for placement of luminescent and/or light productionelement(s) for visualization, for example, tritium and the like.

The shape of lysing member/lysing rod 160 may also be important as tothe most efficient and safe means to transfer electrosurgical energyfrom the lysing rod to the tissue(s). Since electrosurgical energyon/under a surface tends to move toward edges of an object, a lysing rodwith a circular cross section may force current to the opposing lysingrod tips and/or protuberances creating hot spots at/near adjacent beadsand/or protuberances. Therefore, it may be beneficial for lysing rod 160to comprise a non-circular cross section with substantially uniformedges along its length from which electrosurgical energy may uniformlybe transferred to tissues. In contemplated embodiments, a pentagonal orhexagonal cross-sectional shape may be preferable. In other embodiments,spacers with non-circular cross-sections may accumulate less debrisand/or eschar on lysing rod and/or spacer because debris may have a moredifficult time adhering to an angled edge when forces are applied to thedebris.

In alternative embodiments, system 100 may be delivered into the bodyvia a cannula and/or trocar as shown in FIGS. 8 a -8 d.

Grasping/control instrument 190 may comprise means for grasping and/orcontrolling lysing tip 110. “Controlling” herein may be described asincluding, but not limited to, the physical movement of lysing tip inany direction and/or orientation and the conduction of electrosurgicalenergy to lysing tip.

The deployment assembly of system 100 may further comprise a handleassembly 60 that may be used to selectively deploy via shaft 191 lysingtip 110 and control various aspects of its delivery and/or use duringsurgery. Handle assembly 60 comprises a body 61 coupled with a pistolgrip 62. Shaft 191 may extend from and be coupled with handle assembly60. A rocker assembly 65 or another such control means may be providedfor actuation of various features/functions/elements in system 100. Forexample, rocker assembly 65 may be coupled with cords (not shown) suchthat, upon pressing rocker assembly 165 along a top portion of theassembly, one or more of jaw assemblies 193/194 may open or close.

An electrosurgical actuation button 167 a may be provided, which asurgeon may use to initiate transmission of electrosurgical energy tolysing tip 110. More particularly, electrosurgical actuation button 167a may be used to initiate transmission of electrosurgical cutting orblended energy to lysing tip 110. Additionally, a second electrosurgicalactuation button 167 b may be positioned to enable delivery of anothertype of energy to lysing tip 110. Buttons 167 a/b may be positioned onrocker assembly 65 if desired or at the location of button 167 b, asshown in FIG. it. Pressing or otherwise actuation of buttons 167 a/b mayresult in delivery of such energy from an electrosurgical generatorcoupled with handle assembly 60. Handle assembly 60 may also be used inconnection with any of the other embodiments disclosed herein.

It should be understood that handle assembly 60 may be used inconnection with one or more of the other systems disclosed herein. Ofcourse, those of ordinary skill in the art will appreciate that anyother handle assembly, gun, or other available control mechanism mayalso be used, as desired.

Handle assembly 60 may be more conducive to procedures in which thelysing tip is intended for use within a lumen of the body and/or throughcannulas/trocars that act as corridors from outside the body to insidethe body. In alternative embodiments, hand assembly 60′ depicted inFIGS. 1 u-v , may provide the surgeon with a more optimal and/orcomfortable means to manipulate lysing tip 110 via shaft 191′. In thisembodiment, as more precisely shown in cross-sectional FIG. 1 v ,pushrod 190 p within shaft 191′ may reversibly or permanently couplewith coupling linkage 64. In alternative embodiments, coupling means 63may be used to facilitate the coupling between pushrod 190 p andcoupling linkage 64. As the user moves toggle 65′ back and forth,coupling linkage 64 is likewise moved and transfers its directionalmovement to pushrod 190 p that opens and/or closes one or both jawassemblies 193/194. Delivery of one or more energy types of energy maybe actuated via buttons 167 a′ and 167 b′ in order to causeelectrosurgical generator to deliver a particular type ofelectrosurgical energy to lysing tip 110 via handle assembly 60′ andshaft 191.

FIGS. 2 a-2 m depict an embodiment of a CDTD or non-CDTD system 200.System 200 comprises a plurality of protrusions 201 defined by beads 251and jaw covers 293 aa/294 aa and recessions 202 positioned in betweenadjacent beads 251 and jaw covers 293 aa/294 aa. System 200 comprises alysing tip 210 that is configured to be completely separable from anyother element of the system, however, lysing tip 210 may be configuredto work in conjunction with the substantially ellipsoidal distal end ofjaw assemblies 293/294 of grasping/control instrument 290 to serve as a“pseudo-bead” during an electrosurgical procedure. Grasping/controlinstrument may comprise grasping channel 297 (which may further comprisean electrosurgical energy transfer opening 287. Channel 297 may beconfigured to receive and/or hold lysing rod 260.

Lysing tip 210 may comprise two beads 251 a/251 b positioned at oppositeend of lysing member 260. Lysing member 260 may be divided into lysingsegments 261 a (covered by spacer 262) and 261 b. In other embodiments,other features may be included to limit or selectively allow forrotation such as welds and/or spacers (for example, spacer 262 extendingfrom the inside of the bottom bead, as shown in FIG. 2 f to the jawassemblies 293/294). In some embodiments, spacers may be positionedadjacent to opposing outer beads such that jaws may grip lysing rod inbetween the two spacers. Such spacers may be used to either inhibit orselectively limit rotation by, for example, their shape, and/orproximity to jaw assemblies 293/294. This alternative embodiment may beapplied to other embodiments herein. In alternative embodiments, spacers262 may be replaced with spacers of any shape, including but not limitedto those depicted in FIGS. 7 h to 7 t . In the depicted embodiment,beads 251 a/b may rotate about lysing rod 260, thus, a surgeon may beable to dissect on one or more of the sides of the dissection plane onthe backstroke, possibly making surgery more efficient via dissecting inthe reverse direction. Beads 251 a/b may be configured to rotate aboutlysing rod 260 such that the distal ends of the beads become theproximal ends when the motion of the lysing tip is reversed.

In the depicted embodiment, a moveable sheath 295 external to thegrasping control device 290 may reduce electrosurgical discharge bypreventing upper and lower conductive jaw armature 293 a/294 a frombeing exposed to bodily fluids, charred material, and debris. Themoveable sheath 295 is usually present along a substantial length of theshaft 291 of the grasping control instrument 290. Sheath 295 may becomprised of plastic, silicone, ceramic, cermet, halogenatedhydrocarbon, and/or other nonconductive materials. Sheath 295 may bedisposable, thereby facilitating cleaning of the instrument andreplacement of sheath. Prior to use, sheath 295 may be slid into aposition to expose the metal armature of the jaw assemblies tofacilitate cleaning. During delivery and use, sheath 295 may be sliddistally until the distal end of sheath 295 contacts the most distal ribof ribs 289 a of jaw coverings 293 aa/294 aa. Upper and lower jawcoverings 293 aa and 294 aa may be nonconductive and specially shapedwith ribs 289 a/289 b and/or ridges and/or surface features so as toprevent outer sheath 295 overlying shaft 291 from sliding to an unwantedposition. Sheath 295 and ribs 289 a may also, when suitably positioned,form a seal to prevent unwanted electrical discharge. In someembodiments, ribs 289 a/289 b may also provide the surgeon with aphysical end point to the extension of sheath 295.

While the grasping/control instrument 290 is energized withelectrosurgical energy, beads 251 a/251 b and upper and lower jawcoverings 293 aa and 294 aa are preferably non-conductive, thusminimizing unwanted electrical discharge. Each upper and lower jawassembly 293/294 respectively, may therefore be comprised of upper andlower jaws 293 a/294 a (that may be conductive and/or metallic) andnon-conductive upper and lower jaw coverings 293 aa/294 aa,respectively. Upper and lower jaws 293 a/294 a may comprisecorresponding distal jaw tongues 293 a′/294 a′. The inside of one orboth non-conductive jaw coverings 293 aa and 294 aa may be formed withone or more receiving chambers 288 a (lower jaw covering depicted, upperjaw covering not depicted) respectively, to receive their correspondingconductive tongues 293 a′ or 294 a′. The electrically conductive tongues293 a′ and/or 294 a′ may be configured to deliver electrosurgical energythrough electrosurgical energy transfer opening 287 in one or more ofthe nonconductive jaw coverings 293 aa/294 aa in order to permitelectrosurgical energy flow to lysing rod 260.

In this embodiment, opening 287 and slot 297 may be formed so as allow aportion of tongue 294 a′ to protrude into slot 297 to allow for directcontact between lysing rod 260 and tongue 294 a′, as best shown by thecross section in FIG. 2 h . Nonconductive jaw coverings 293 aa/294 aamay be comprised of ceramic, cermet, glass, various halogenatedhydrocarbons, and any other suitable nonconductors. Nonconductive jawcoverings 293 aa/294 aa may be restricted in their motion and/or affixedto conductive tongues 293 a′/294 a′ via one or more cover welds placedin cover weld holes 293 c/294 c, said welds may be affixed to eachtongue thus restricting movement of the corresponding jaw covering. Whenan electrosurgical generator is activated by a surgeon, electrosurgicalenergy may be transmitted through the metal pushrod 290 p, throughlinkage 290L, and through upper and/or lower jaws 293 a/294 a coupled tojaw tongues 293 a′/294 a′. The pivot points along the electrical pathmay be coupled in ways commonly known in the art and as previouslymentioned, for example, via pins.

Jaw assemblies 293/294 may be comprised of single action or doubleaction jaws that may, but need not, open more than 10 to 15 degreesrelative to one another.

In some embodiments, lysing tip 210 may be configured to prevent orlimit lateral movement of outer beads 251 a/b by, as previouslydescribed, joining spheroids 260 a or other bulbs via weld to lysing rod260 within rod tunnels (tunnels 154 a/154 b shown in FIG. 1 b ) andcorresponding bead holes (holes 155 a/155 b intersect tunnels shown inFIG. 1 c ). In some embodiments, other objects may be welded or glued toeffectively couple the beads 251 a/251 b to lysing rod 260. In thedepicted embodiment, metallic spheroids 260 a such as ball bearings maybe passed down bead hole and welded to the ends of lysing rod 260. Thismay allow for rotational movement of beads around the lysing rod 260.Any suitable welding technique may be used, however, resistance weldingmay be preferred. In the depicted embodiment, beads 255 a/b are about 4mm in length, bead tunnel is about 0.55 mm in diameter containing lysingrod 260 about 0.5 mm in diameter, and/or bead hole is about 0.8 mm indiameter which can capacitate the transport and welding of an about 0.7mm metallic spheroids 260 a. The diameter of metallic spheroids 260 a ispreferably larger than bead tunnel so once welded, now-welded metallicspheroids 260 a prevent the lysing rod 260 from being withdrawnthrough/from tunnel. In some embodiments, other geometric shapes may beused that prevent the lysing rod 260 from being withdrawn through/fromtunnel. The spheroidal shape of a ball bearing or substantiallyspheroidal shape of a polyhedron may still allow for rotation of beads251 a/b provided the tunnel sizes and weld sizes permit.

In alternative embodiments, the dimensions of lysing rod 260 may bemodified to approach the width and/or thickness of lysing plates asshown in FIGS. 4 a -4 j.

While traditional non-conductive coatings of metallic parts may beapplied to the distal grasper's jaws and armature, such coatings may notbe as effective at preventing electrical discharge after a certainnumber of uses and/or cleaning cycles. Using ceramics and/or more robustnon-conductive materials to make the jaw coverings may allow for agreater number of cleaning cycles thus providing more cost value tosurgeons and/or patients.

In alternative embodiments such as that depicted in FIG. 2 m , thelysing rod 260 and/or lysing tip 210 may be manipulated within a trocarand/or cannula and/or internal body cavity via loop 244 which maycomprise a biodegradable substance which may also comprise absorbablesuture, gelatin, wax, etc. In contemplated embodiments, a loop maycomprise absorbable suture material, including but not limited topolyglycaprone, polyglycolic acid, polylactic acid, and polydioxanone.An opposing grasping instrument may temporarily grasp loop 244 to holdlysing tip 210 in place while the jaws of the treatment/graspinginstrument 290 lock down on the desired portion of the lysing rod 260and/or lysing tip 210. Once the device is electrosurgically activatedand discharges energy and significant temperatures are generated, thebiodegradable loop 244 may be configured to melt or decompose thusexposing the desire portions of lysing rod 210 so treatment maycommence. Various shapes of loop 244 may be used varying from thesimplest of tied suture knots to the bubble-blower shaped shown in FIG.2 m to a simple rectangle with a hole that allows string passage like aluggage ticket string. Alternatively, loop 244 may be glued on to lysingrod 260 with a biocompatible glue that may decompose at the hightemperatures of electrosurgery which may vary from 100° C. to theextremes of electrical discharge within the body. In additionalembodiments, a tab may be coupled with the lysing tip to/from facilitatetransfer to a grasping control instrument in a similar manner such asthe tab 860 t shown in FIGS. 8 a & 8 b.

In other embodiments, system 200 may be modified to include a tetherpermanently or reversibly attached to lysing rod 260 that is threadedthrough an opening in one or both of jaw assemblies 293 and/or 294. Forexample, prior to a procedure, a biocompatible thread may be tied viaknot to lysing rod 260 and threaded through an opening in one jaw. Thethreaded lysing tip 210 may be passed through an incision into the bodyor through a cannula/trocar, perhaps aided by the jaws of graspingcontrol instrument 290. Once the tip of grasping/control instrument 290is in a location with space sufficient for coupling, the tether may bepulled tight either manually or by way of a mechanism, thus directinglysing rod 260 into slot 297.

FIGS. 3 a-3 i depict another embodiment of a CDTD or non-CDTD system300. System 300 comprises a lysing tip 310 comprising protrusions 301and recessions 302 defined by the regions between adjacent beads 351a/b/c/d and, more particularly, a lysing member comprising a lysingplate 360 extending along tip 310. System 300 comprises a lysing tip 310that may be configured to be completely separable from any other elementof the system. However, in some embodiments, lysing tip 310 may beconfigured to work in conjunction with the substantiallyellipsoidal-shape at the distal end of jaw assemblies 393/394 ofgrasping/control instrument 390, as this preferably insulated shape mayserve the same functions as beads 351 ab/c/d as previously discussed.Thus, the shape of the distal end of grasping/control instrument 390 maymimic the shape of the distal ends of each of the various beads 351Lysing tip 310 comprises four beads 351 a/b/c/d. One of these beads 351d is positioned at a first end of lysing tip 310 and beads 351 a-cextend along lysing member 360 in a row adjacent to bead 351 d. Ratherthan having a bead positioned opposite from bead 351 d, a bulbousterminus 361 is provided at the opposite end. Bulbous terminus 361 maycomprise, for example, a spherical or semi-spherical (frusto-spherical,for example) shape that, as discussed below, may be used to allow for asuitable instrument, such as grasping/control instrument 390, to holdand/or manipulate lysing tip 310 during a surgical procedure. Althoughit may be preferred to position bulbous terminus 361 at a terminal endof lysing tip 310, other embodiments are contemplated in which a bulb orother structure used for grasping and/or controlling may be positionedat another location along lysing member 360 and/or tip 310.

In system 300, lysing plate 360 may be inserted through and/or into thebeads 351 via widened tunnels 354 and maintained in place by a welds orglues or other fasteners placed in holes 355 in the rear of thefrusto-shaped beads. In other embodiments, holes 355 to facilitatewelding or otherwise coupling of beads 351 a/b/c/d (collectively 351) tolysing plate 360 may exit beads 351 a/b/c/d in any number of locations.The dimensions of the lysing plate may be approximately 0.3 mm inthickness and approximately 2 mm in width by approximately 7 mm inlength. However, in further contemplated embodiments, these dimensionsmay be ⅓ to 10× in number. System 300 may be configured to prevent orlimit lateral movement of beads 351 by fixing bead holes 355 in thebeads and to corresponding lysing plate weld zones. Alternatively, asubstantially solid object like a pin or glue may be inserted toeffectively couple the beads 351 to the lysing plate 360 ifcorresponding holes are made in lysing plate 360. In alternativeembodiments, holes in lysing plate 360 may be replaced with grooves thatmay receive the solid object(s) inserted through fixing bead holes 355.

In the depicted embodiment, lysing member 360 comprises plate 360 whichmay comprise proximal lysing plate 360 p and a grasping terminuscomprising a bulbous terminus 361. In the depicted embodiment, thegrasping terminus is a metallic spheroid 361, which may be configured tomatch the shape of a corresponding feature of one or both jaws ofinstrument 390. Although this shape may allow for some rotation/pivotingof tip 310 while within instrument 390, as described in greater detailbelow, other shapes are contemplated in which this shape may vary. Thus,the grasping and/or bulbous terminus 361 may comprise a geometricallyshaped terminus 361 such as spheroid, polyhedron, etc. Upon beinggrasped by grasping/control instrument 390 to perform a surgicalprocedure, in some embodiments, the distal end of jaw assemblies 393/394of grasping/control instrument 390 may substantially mimic the shapeand/or function of beads 351 a/b/c/d such that lysing segments aredefined between each bead 351 a/b/c/d and between the jaw assemblies393/394 and bead 351 a. In some embodiments, the portion of jawassemblies 393/394 extending onto or beyond lysing plate 360 may have anidentical or at least similar distal shape and size to beads 351. Forexample, this distal portion of jaw assemblies 393/394 may haverounded/smooth surfaces that taper towards a rounded tip similar tobeads. At the very least, it is preferred that distal tip jaw assemblies393/394 be shaped and sized such that the adjacent portion of lysingplate 360 can come in contact with or near contact with target tissues.Together, beads 351 and distal portion of jaw assemblies 393/394 mayfunction as blunt dissectors to separate tissues without cutting. Whilethe device is energized with electrosurgical energy, beads 351 and theouter surfaces of jaw assemblies 393/394 are preferably non-conductivein order to perform the blunt dissection function. The inside of one orboth jaw assemblies 393/394 and/or its corresponding lower jaw define areceiving slot 397. In some embodiments, receiving slot 397 may beformed in a cover, as previously mentioned, that may fit over one orboth jaws of instrument 390. Alternative embodiments are contemplated,however, in which receiving slot 397 may be formed directly in one orboth of the jaws themselves.

In the depicted embodiment, receiving slot 397 may comprise a treatmentlocking portion 397 a, which may comprise a flattened groove, which maybe configured to match the shape of lysing member 360 at one end nearterminus 361. Receiving slot 397 may further, or alternatively solely,comprise a rotational portion 397 b, which may comprise a roundedopening, which may be configured to rotationally engage bulbous terminus361 and allow for rotation between delivery and treatmentconfigurations. In some embodiments, a similarly rotational slot may beformed in the opposing jaw. In the depicted embodiment, receiving slot397 may also serve as an opening for delivery of electrosurgical energyfrom instrument 390 through a jaw cover and into lysing member 360.Thus, rotational portion 397 b may coincide with an opening 387 in lowerjaw covering 394 aa. Upon placement of the grasping/bulbous terminus 361into the opening-to-electroconductivity 387 of the receiving slot 397,if electrosurgical energy is applied to the grasping/control device 390,electrosurgical energy may pass through the lysing plate 360 into targettissues when in proper proximity. Preferably, bulbous terminus 361,opening 387, and jaw 394 are configured so as to facilitate directcontact between a conductive jaw or jaw portion and bulbous terminus361.

FIGS. 3 b, 3 c, and 3 d depict the system 300 in the treatmentconfiguration in which the lysing plate is locked between the jawassemblies 393/394 and held in place at the proximal lysing plate 360 pand grasping terminus 361 by virtue of their fitting like a key and alock into receiving slot 397 and electro-conductiveopening-to-electroconductivity 387 in lower jaw covering 394 aa.

FIG. 3 e depicts the system 300 in the delivery/deployment configurationin which the lysing plate 360 is held approximately parallel to the axisof the shaft 390 a. The proximal lysing plate 360 p lies between theslightly open jaw assemblies 393/394. The proximal lysing plate 360 maybe prevented from falling out of the jaws by virtue that the spheroid atthe grasping terminus 361 being captured by theopening-to-electroconductivity 387 as well as, in some embodiments, acorresponding opening in the upper jaw assembly 393 to receive the upperportion of grasping terminus 361. Thus, upon delivery of lysing tip 310into a human body, which may be done via cannula, for example, in thedelivery configuration of FIG. 3 e , the lysing tip 310 may be rotatedand seated within receiving slot 397 in the treatment configuration ofFIG. 3 d.

In some embodiments, lysing member 360 may comprise a rigid and/orsubstantially rigid wire. In such embodiments, one or both of jawassemblies 394/394 may be modified in shape at thetreatment-position-locking-slot to accommodate the size of the rigidwire. In some embodiments, such a rigid wire may also comprise agrasping terminus, which may be provided at a distal end of the wire.

In some embodiments, spacers may be positioned adjacent to opposingbeads 351 and/or between bead 351 a and terminus 361 such that rotationor movement may be modified. Such spacers may be used to either inhibitor selectively limit rotation by, for example, their shape, and/orproximity to jaw assemblies 393/394. In this embodiment, a surgeon maybe able to dissect on one or more of the sides on the backstroke,possibly making surgery more efficient. In some preferred embodimentsand implementations, allowing for reverse dissection.

In alternative embodiments, beads 351 may be replaced with beads of anyshape, including but not limited to those depicted in FIGS. 7 aa to 7zzz. In some embodiments wherein a spacer is positioned between a lysingrod and grasper jaws, the tolerance between the lysing rod and a spacermay allow for rotation of the lysing rod within the spacer and thusallow for rotation of beads with respect to a spacer and/or grasper. Thetolerance may be adjusted to allow for a predetermined amount ofrotation.

In the depicted embodiment, a moveable sheath 395 external to thegrasping control device 390 may reduce electrosurgical discharge bypreventing upper and lower conductive jaw armature from being exposed tobodily fluids, charred material, and debris. The moveable sheath 395 maybe slidably positionable along a substantial length of the shaft 390 aof the grasping control instrument 390. Sheath 395 may be comprised ofplastic, silicone, ceramic, cermet, halogenated hydrocarbon, and/orother nonconductive materials. Sheath 395 may be disposable tofacilitate cleaning of the instrument 390 and/or replacement of sheath395. Prior to use, sheath 395 may be slid into a position to expose themetal armature of the jaw assemblies to facilitate cleaning. Duringdelivery and use, sheath 395 may be slid distally until the distal endof sheath 395 contacts one or both of ribs 389 a of jaw coverings 393aa/394 aa. Upper and lower jaw coverings 393 aa and 394 aa may benonconductive and specially shaped with ribs 389 a and/or ridges and/orsurface features so as to prevent outer sheath 395 overlying shaft 390 afrom sliding to an unwanted position. Sheath 390 and ribs 389 a as well,when suitably positioned, may form a seal to prevent unwanted electricaldischarge. Another feature of ribs 389 a is to provide the surgeon witha physical end point to the extension of sheath 395.

While the grasping/control instrument 390 is similar to grasping controlinstruments 190 and 290 such that when energized with electrosurgicalenergy, beads 351 and upper and lower jaw coverings 393 aa and 394 aaare preferably non-conductive, thus minimizing unwanted electricaldischarge. Each upper and lower jaw assembly 393/394 respectively, maybe comprised of upper and lower jaws 393 a/394 a (that may be conductiveand/or metallic) and upper and lower jaw coverings 393 aa/394 aa,respectively. Upper and lower jaws 393/394 may comprise correspondingdistal jaw tongues, as previously described. The inside of one or bothnon-conductive jaw coverings 393 aa and 394 aa may be formed with one ormore receiving chambers 388 a (receiving chamber for lower jaw covering394 aa not shown) respectively, to receive their correspondingconductive tongues. The electrically conductive tongues and/or may beconfigured to deliver electrosurgical energy through electrosurgicalenergy transfer opening 387 in one or more of the nonconductive jawcoverings 393 aa/394 aa in order to permit electrosurgical energy flowto or from one or more electro-conductive tongues to the terminus 361 oflysing plate 360. Nonconductive jaw coverings 393 aa/394 aa may becomprised of ceramic, cermet, glass, various halogenated hydrocarbons,and any other suitable nonconductors. Nonconductive jaw coverings 393aa/394 aa may be restricted in their motion and/or affixed to conductivetongues via one or more cover welds placed in cover weld holes 393 c/394c, said welds may be affixed to each tongue thus restricting movement ofthe corresponding jaw covering. When an electrosurgical generator isactivated by a surgeon, electrosurgical energy may be transmittedthrough a metal pushrod, and/or linkage, as previously described. Thisenergy may then be delivered through upper and/or lower jaws 393/394through their respective jaw tongues. The pivot points along theelectrical path may be coupled in ways commonly known in the art, forexample, via pins.

Jaw assemblies 393/394 may be comprised of single action or doubleaction jaws that may, but need not, open more than 10 to 15 degreesrelative to one another in order to accept/capture the terminus 361 oflysing member 360.

In the depicted embodiment, 347 represents an antenna configured todeliver a signal to a receiver unit. In some embodiments, antenna 347may comprise radiofrequency identification (RFID) TAG. In someembodiments the RFID tag may comprise an RFID transponder. In otherembodiments the RFID tag may comprise a passive tag. It should beunderstood that antenna 347 is not depicted in every one of the otherfigures; any of the embodiments described herein may comprise one ormore such elements. Other embodiments may comprise one or more antennaon any other suitable location on the embodiment, including but notlimited to on the protrusions or otherwise on the tip, and on the shaft.In embodiments in which antenna 347 comprises an RFID transponder, theRFID transponder may comprise a microchip, such as a microchip having arewritable memory. In some embodiments, the tag may measure less than afew millimeters. In some embodiments a reader may generate analternating electromagnetic field which activates the RFID transponderand data may be sent via frequency modulation. In an embodiment, theposition of the RFID tag or other antenna may be determined by analternating electromagnetic field in the ultra-high frequency range. Theposition may be related to a 3-dimensional mapping of the subject. In anembodiment the reader may generate an alternating electromagnetic field.In some such embodiments, the alternating electromagnetic field may bein the shortwave (13.56 MHz) or UHF (865-869 MHz) frequency. Examples ofpotentially useful systems and methods for mapping/tracking a surgicalinstrument in relation to a patient's body may be found in U.S. PatentApplication Publication No. 2007/0225550 titled “System and Method for3-D Tracking of Surgical Instrument in Relation to Patient Body”, whichis hereby incorporated by reference in its entirety.

In some embodiments, a transmission unit may be provided that maygenerate a high-frequency electromagnetic field configured to bereceived by an antenna of the RFID tag or another antenna. The antennamay be configured to create an inductive current from theelectromagnetic field. This current may activate a circuit of the tag,which may result in transmission of electromagnetic radiation from thetag. In some embodiments, this may be accomplished by modulation of thefield created by the transmission unit. The frequency of theelectromagnetic radiation emitted by the tag may be distinct from theradiation emitted from the transmission unit. In this manner, it may bepossible to identify and distinguish the two signals. In someembodiments, the frequency of the signal from the tag may lie within arange of the frequency of the radiation emitted from the transmissionunit. Additional details regarding RFID technology that may be useful inconnection with one or more embodiments discussed herein may be foundin, for example, U.S. Patent Application Publication No. 2009/0281419titled “System for Determining the Position of a Medical Instrument,”the entire contents of which are incorporated herein by specificreference.

In other embodiments, antenna 347 may comprise a Bluetooth antenna. Insuch embodiments, multiple corresponding Bluetooth receivers at knownlocations may be configured to sense signal strengths from the Bluetoothantenna 347 and triangulate such data in order to localize the signalfrom the Bluetooth antenna 347 and thereby locate the lysing tip withina patient's body. Other embodiments may be configured to useangle-based, electronic localization techniques and equipment in orderto locate the antenna 347. Some such embodiments may comprise use ofdirectional antennas, which may be useful to increase the accuracy ofthe localization. Still other embodiments may comprise use of othertypes of hardware and/or signals that may be useful for localization,such as WIFI and cellular signals, for example. Antenna 347 may belocated within holes 355′.

One or more receiver units may be set up to receive the signal from thetag. By evaluating, for example, the strength of the signal at variousreceiver units, the distances from the various receiver units may bedetermined. By so determining such distances, a precise location of thelysing tip relative to a patient and/or a particular organ or othersurgical site on the patient may be determined. In some embodiments, adisplay screen with appropriate software may be coupled with the RFID orother localization technology to allow a surgeon to visualize at leastan approximate location of the tag/antenna, and therefore the lysingtip, relative to the patient's body.

Some embodiments may be further configured such that data from theantenna(s) may be used in connection with sensor data from the device.For example, some embodiments comprising one or more sensors 348 may befurther configured with one or more RFID tags. As such, data from theone or more sensors may be paired or otherwise used in connection withdata from the one or more RFID tags or other antennas. For example, someembodiments may be configured to provide information to a surgeonregarding one or more locations on the body from which one or moresensor readings were obtained. In some embodiments, temperature sensorsmay include thermistors and/or thermocouples. To further illustrateusing another example, information regarding tissue temperature may becombined with a location from which such tissue temperature(s) weretaken. In this manner, a surgeon may be provided with specificinformation regarding which locations within a patient's body havealready been treated in an effective manner and thus which locationsneed not receive further treatment using the device.

In some such embodiments, a visual display may be provided comprising animage of the patient's body and/or one or more selected regions of apatient's body. Such a system may be configured so as to provide avisual indication for one or more regions within the image correspondingto regions of the patient's tissue that have been sufficiently treated.For example, a display of a patient's liver may change colors atlocations on the display that correspond with regions of the liver thathave experienced a sufficient degree of fibrosis or other treatment.Such regions may, in some embodiments, be configured such that pixelscorresponding to particular regions only light up after thecorresponding tissue in that region reaches a particular thresholdtemperature.

Such sensor 348 may be coupled with an antenna, which may send and/orreceive one or more signals to/from a processing unit. Alternatively, oradditionally, data from such sensors resulting from tissue and/or fluidanalysis using such sensors may be stored locally and transmitted later.As yet another alternative, such a signal may be transmitted followingsurgery. In such implementations, the signals need not necessarily betransmitted wirelessly. In fact, some embodiments may be configured tostore data locally, after which a data module, such as a memory stick,may be removed from the device and uploaded to a separate computer foranalysis. Sensor 348 may be located within holes 355′.

In alternative embodiments, energy windows 306 may be positioned withinbead holes 355′ or on a surface of bead 351 and may be configured todeliver energy of a different type in a different direction. Forexample, in FIG. 3 h , energy windows 306 may direct energyperpendicular to the forward motion direction of lysing tip 310 and/ormay be configured to deliver another type of electrosurgical energy, orenergy of different modalities, including, but not limited to, laser,intense pulse light, resistive heating, radiant heat, thermochromic,ultrasound, mechanical, and/or microwave.

FIGS. 4 a-4 j depict an embodiment of a CDTD or non-CDTD system 400.System 400 comprises a plurality of protrusions 401 defined by beads 451and jaw covers 493 aa/494 aa and recessions 402 positioned in betweenadjacent beads 451 and jaw covers 493 aa/494 aa. System 400 comprises alysing tip 410 that is configured to be completely separable from anyother element of the system, however, lysing tip 410 may be configuredto work in conjunction with the substantially ellipsoidal distal end ofjaw assemblies 493/494 of grasping/control instrument 490 to serve as a“pseudo-bead” during an electrosurgical procedure. Lysing tip 410comprises a plurality of beads 451 positioned on lysing member 460 whichcomprises lysing plate 460. Lysing plate 460 may also comprise agrasping/control instrument interface 461 a which comprises a protrudingconductive-metal hemisphere or other protruding member that isconfigured to be engaged with a corresponding feature on one or both jawassemblies 493/494. It should be noted that in the embodiments of 4 a-4j, beads 451 are supported laterally by lysing plate 460. It should alsobe noted that beads 451 lack a base, such as base 105 for system 100detailed in U.S. patent application Ser. No. 15/464,199 and insteaddefine a lysing tip that lacks structure immediately behind the beadsfor support. It should also be noted that lysing tip 410 comprises beads451 that project both distally and proximally relative to lysing plate460.

Grasping/control instrument 490 may comprise grasping channel 497 (whichmay further comprise an electrosurgical energy transfer opening 487.Channel 497 may be configured to receive and/or hold lysing plate 460.The leading edge of lysing plate 460 may comprise a beveled feature 460b which may cause the lysing tip 460 to rise when traversing tissue ifpositioned on the bottom of lysing tip 460. This feature 460 b may alsobe sharpened to facilitate transfer of electrosurgical energy in adesired manner and/or allow for manually dissection in the absence ofelectrosurgical energy.

In the depicted embodiment, a moveable sheath 495 external to thegrasping control device 490 may reduce electrosurgical discharge bypreventing upper and lower conductive jaw armature 493 a/494 a frombeing exposed to bodily fluids, charred material, and debris. Themoveable sheath 495 is usually present along a substantial length of theshaft 491 of the grasping control instrument 490. Sheath 495 maycomprise plastic, silicone, ceramic, cermet, halogenated hydrocarbon,and/or other nonconductive materials. Sheath 495 may be disposable,thereby facilitating cleaning of the instrument and replacement ofsheath. Prior to use, sheath 495 may be slid into a position to exposethe metal armature of the jaw assemblies to facilitate cleaning. Duringdelivery and use, sheath 495 may be slid distally until the distal endof sheath 495 contacts the most distal rib of ribs 489 a of jawcoverings 493 aa/494 aa. Upper and lower jaw coverings 493 aa and 494 aamay be nonconductive and specially shaped with ribs 489 a and/or ridgesand/or surface features so as to prevent outer sheath 495 overlyingshaft 491 from sliding to an unwanted position. Sheath 495 and ribs 489a may also, when suitably positioned, form a seal to prevent unwantedelectrical discharge. In some embodiments, ribs 489 a may also providethe surgeon with a physical end point to the extension of sheath 495.

While the grasping/control instrument 490 is energized withelectrosurgical energy, beads 451 and upper and lower jaw coverings 493aa and 494 aa are preferably non-conductive, thus minimizing unwantedelectrical discharge. Each upper and lower jaw assembly 493/494respectively, may therefore be comprised of upper and lower jaws 493a/494 a (that may be conductive and/or metallic) and non-conductiveupper and lower jaw coverings 493 aa/494 aa, respectively. Upper andlower jaws 493 a/494 a may comprise corresponding distal jaw tongues 493a′/494 a′. The inside of one or both non-conductive jaw coverings 493 aaand 494 aa may be formed with one or more receiving chambers 488 a(lower jaw covering depicted, upper jaw covering not depicted)respectively, to receive their corresponding conductive tongues 493 a′or 494 a′. The electrically conductive tongues 493 a′ and/or 494 a′ maybe configured to deliver electrosurgical energy through electrosurgicalenergy transfer opening 487 in one or more of the nonconductive jawcoverings 493 aa/494 aa in order to permit electrosurgical energy flowto lysing plate 460

In this embodiment, opening 487 and slot 497 may be formed so as allow aportion of tongue 494 a′ to protrude into slot 497 to allow for directcontact between lysing plate 460 and tongue 494 a′, as best shown by thecross section in FIG. 4 i . Nonconductive jaw coverings 493 aa/494 aamay be comprised of ceramic, cermet, glass, various halogenatedhydrocarbons, and any other suitable nonconductors. Nonconductive jawcoverings 493 aa/494 aa may be restricted in their motion and/or affixedto conductive tongues 493 a′/494 a′ via one or more cover welds placedin cover weld holes 493 c/494 c, said welds may be affixed to eachtongue thus restricting movement of the corresponding jaw covering. Whenan electrosurgical generator is activated by a surgeon, electrosurgicalenergy may be transmitted through the metal pushrod 490 p, throughlinkage 490L, and through upper and/or lower jaws 493 a/494 a coupled tojaw tongues 493 a′/494 a′. The pivot points along the electrical pathmay be coupled in ways commonly known in the art and as previouslymentioned, for example, via pins.

Jaw assemblies 493/494 may be comprised of single action or doubleaction jaws that may, but need not, open more than 10 to 15 degreesrelative to one another.

In some embodiments, lysing tip 410 may be configured to prevent orlimit lateral movement of outer beads 451 by, as previously described,joining spheroids or other objects via weld to lysing plate 460 withinthe intersection of plate tunnel 454 and bead holes 455 as describedpreviously. In some embodiments, other objects may be welded or glued toeffectively couple the beads 451 to lysing plate 460. In the depictedembodiment, metallic spheroids 460 a such as ball bearings may be passeddown bead hole and welded to the ends of or the top of the ends oflysing plate 460. Any suitable welding technique may be used, however,resistance welding may be preferred. In some embodiments, othergeometric shapes may be used that prevent the lysing plate 460 frombeing withdrawn through/from tunnel. The spheroidal shape of a ballbearing or substantially spheroidal shape of a polyhedron may stillallow for rotation of beads 451 provided the tunnel sizes and weld sizespermit. In some embodiments, pins, screws, rivets or the like or epoxy,or metallic welds may extend through vertical holes 455 to affix the twoelements together. In alternative embodiments, holes 455 may be replacedby bevels. Thus, in some embodiments, horizontal and/or vertical tunnelsmay not be needed. However, in other embodiments, plate 460 may comprisebeveled or narrowed regions configured to fit within such tunnels formedwithin beads 451. Because use of a plate 460 may provide more rigiditythan certain other embodiments, use of spacers may not be needed forlysing tip 410. Beads 451 may comprise facets 452.

FIGS. 5 a-h depict a TMT system 500 comprising a free-floating tissuemodification tip (TMT) 511 that may couple to grasping/controlinstrument 590. In this embodiment TMT 511 may comprise a graspingterminus comprising a bulbous portion 506 a. In the depicted embodiment,the grasping terminus comprises a metallic spheroid 506 a, which may beconfigured to match the shape of a corresponding feature of one or bothjaws of instrument 590. Although this shape may allow for somerotation/pivoting of tip 510 while within instrument 590, as describedin greater detail below, other shapes are contemplated in which thisshape may vary. Thus, the grasping and/or bulbous terminus 506 a maycomprise a geometrically shaped terminus 506 a such as polyhedron, etc.Upon being grasped by grasping/control instrument 590 to perform asurgical procedure, in some embodiments, energy, such as electrosurgicalenergy, may be delivered from one or both of jaw assemblies 593/594 ofinstrument 591, such as tongues 593 aa/594 aa of these jaws. Aspreviously mentioned, the inside of one or both of these jaws may definea receiving slot 597, which may be configured to engage terminus 506 aand allow for contacting with a conductive portion of one or both jaws,electrosurgical energy transfer opening 587. In some embodiments,receiving slot 597 may be formed in a cover, as previously mentioned,that may fit over one or both jaws of instrument 590. Alternativeembodiments are contemplated, however, in which receiving slot 597 maybe formed directly in one or both of the jaws themselves.

In the depicted embodiment, receiving slot 597 may comprise a treatmentlocking portion 597 a, which may comprise a flattened groove, which maybe configured to match the shape of tip 511 at one end near terminus 506a, such as at flattened region 506. Receiving slot 597 may further, oralternatively solely, comprise a rotational portion 597 b, which maycomprise a rounded opening, which may be configured to rotationallyengage bulbous terminus 506 a and allow for rotation between thedelivery configuration of FIG. 5 b and the treatment configuration ofFIG. 5 a . In some embodiments, a similar rotational slot may be formedin the opposing jaw. In the depicted embodiment, receiving slot 597 mayalso serve as an opening for delivery of electrosurgical energy frominstrument 590 through a jaw cover via electrosurgical energy transferopening 587 and into a conductive portion of tip 511.

More particularly, tip 511 comprises an energy window 508 o that may bepositioned to face an upper and/or lower tissue plane that may havealready been lysed/dissected. A non-conductive cover 508 may have one ormore windows 508 o that may allow for a conductive element 506 t toextend therethrough to provide for delivery of energy, electrosurgicalor otherwise, therethrough. In alternative embodiments, one or more barsor other structural elements may be formed in cover 508, which mayseparate an elongated energy window 506 t into a plurality of isolatedenergy windows. Although energy window 506 t is in the shape of a bar, awide variety of alternative shapes and sizes of energy windows and/orstructures for defining emission regions of energy windows may beprovided as desired. In some embodiments, cover 508 may be formed with aplurality of circular opening. Cover 508 may be over-molded onto tip511. Cover 508 may be produced in two pieces that couple around themetal member 506. In alternative embodiments, the region of energywindow 506 t may comprise one or more (a plurality of) energy emitterspositioned in a manner to optimize the intended tissue modificationeffect.

As previously mentioned, rotational portion 597 b may coincide with anopening 587 in lower jaw covering 594 aa. Upon placement of thegrasping/bulbous terminus 506 a into the opening-to-electroconductivity587 of the receiving slot 597, if electrosurgical energy is applied tothe grasping/control device 590, electrosurgical energy may pass throughthe energy window 506 t into target tissues when in proper proximity.Preferably, bulbous terminus 506 a, opening 587, and jaw 594 areconfigured so as to facilitate direct contact between a conductive jawor jaw portion and bulbous terminus 506 a. Grasping/control instrument590 may comprise shaft 591, pushrod 592, and jaw assemblies 593/594which may be covered by moveable, non-conductive sheath 595.

In alternative embodiments, energy window 506 t may be configured to bepositioned on the bottom of the device. However, in variousimplementations, a surgeon may simply invert the tip of a top-mountedenergy window 506 t so that it points in the opposite direction (forexample, away from the surface skin and toward the subcutaneous tissues.This inward/subcutaneous direction of energy may be useful in directingenergy toward the subcutaneous deposits in cellulite and other cosmeticconditions.

Some embodiments may comprise an energy window 506 t located proximallyto protrusions 201. In the depicted embodiment, energy window system 506t may comprise electrode termini which may be supplied energy from anenergy source via conduits (not shown) that may comprise, for example,wires and/or fiber optic filaments and/or the like. Energy window 506 tmay be configured in any manner to accommodate any energy modality,including, but not limited to, laser, intense pulse light, resistiveheating, radiant heat, thermochromic, ultrasound, mechanical, and/ormicrowave.

In other embodiments depicted in FIGS. 6 a-b , the external sheath 695or, in alternative embodiments, an external surface of a grasping and/orcontrol instrument, may comprise inflatable segments 698 along a portionof the shaft and/or sheath 695, preferably along a distal portion of theshaft and/or sheath 695. Longer cannulas may tend to be lesscontrollable for more distant applications from the entrance wound.Thus, these inflatable segments 698 may be useful especially in cosmeticprocedures, such as cellulite treatment, in order to force the jaws andlysing rod/segment more superficially against the lower dermis. In thedepicted embodiment, two balloon-like, tube-shaped, inflatable segments698 may be present on the distal to mid-distal portions of the sheath.One or more supply tubes 698 s may be coupled to the inflatable segments698. Inflatable segments 698 may measure half the diameter of sleeve695. However, in other embodiments, inflatable segments 698 may varyfrom 1/10^(th) the diameter of the sheath to 10 times the diameter ofthe sheath. Inflatable segments 698 may expand in size (for example,from about 10% to about 10,000%) when filled with fluid, which mayinclude gas, water, carbon dioxide, nitrogen, and the like. The presenceof the inflated segments 698 may facilitate surgery in more distallocations from the entrance wound. Inflatable segments 698 may bedeflated prior to removal of the device. The balloon-like segments 698may be part of the sheath or may be otherwise attached to the sheath,for example, by glue or heat seal and/or ultrasonic seal. Or, asmentioned above, the balloon-like segments 698 may be coupled with aportion of the instrument itself, such as a suitable external surface ofthe instrument in the event that a sheath is not needed. Inflatablesegments 698 may number from 1 to 10 on a given sheath. Inflatablesegments 698 may be comprised of silicone, rubber, plastic, halogenatedhydrocarbon, silastic, vinyl, and the like.

In alternative embodiments, inflatable segments 698 may be replaced withanother means for pressing a portion of a control instrument and/orlysing tip against a tissue to direct the lysing tip towards a desiredtreatment tissue in a direction normal or at least substantially normalto an axis of the control instrument. For example, inflatable segments698 may be replaced with mechanical jack or lift assembly, which maysimilarly be positioned on an exterior surface of a sheath orinstrument. Such mechanical jack/lift assemblies are another example ofa means for pressing a portion of a control instrument and/or lying tipagainst a tissue to direct the lysing tip towards a desired treatmenttissue in a direction normal or at least substantially normal to an axisof the control instrument.

FIGS. 7 a -7 zzz depict 3 general components of the lysing tip andvarious potential shapes: Lysing rod (FIGS. 7 a-7 g ), spacers (FIGS. 7h-7 t ), and beads (FIGS. 7 aa-7 zzz).

FIGS. 7 a-7 g depict various examples of cross-sectional shapes of wiresor other lysing members. In some embodiments, these shapes may be formedby crimping a wire or other suitable lysing member into the desiredshape. Crimping the lysing member may be particularly useful inconnection with certain embodiments and/or implementations of theinvention, as it may facilitate a preferred coupling between variousother elements of the CDTD system, such as the beads and/or spacers.Crimping may also, or alternatively, be useful in providing for apreferred delivery of electrosurgical energy through the wire/lysingmember. Other methods of shaping the lysing member may include but notbe limited to cutting, polishing, forging or forming by extrusion. Inadditional embodiments, various coatings may be applied to lysing rodsthat may reduce adhesion of heated biological material to the lysing rodor spacers.

FIG. 7 a comprises a lysing rod having a circular cross-section. Theshape of lysing member/lysing rods may also be important as to the mostefficient and safe means to transfer electrosurgical energy from thelysing members to the tissue(s). Electrosurgical energy on/under asurface may tend to move toward edges of an object. This shape may beuseful for allowing a useful distribution of a coating to the surface ofthe lysing rod that may be used to reduce char buildup and/or modifyease of movement of a lysing tip through tissue. FIG. 7 b comprises alysing rod having a triangular cross-section; this may be useful formaximizing electrosurgical energy discharge and minimizing char build-upabout the lysing rod. FIG. 7 c comprises a lysing rod having a squarecross-section. FIG. 7 d comprises a lysing rod having a pentagonalcross-section along its length while FIG. 7 dx comprises a lysing rodhaving a pentagonal cross-section that is twisted along its length. FIG.7 e comprises a lysing rod having a hexagonal cross-section. FIG. 7 fcomprises a lysing rod having a wedge-shaped cross-section. FIG. 7 gcomprises a lysing rod having a semi-circular or frusto-circularcross-section.

FIGS. 7 h-7 t depict various shapes for spacers that may be used inconnection with one or more of the embodiments disclosed herein. Eachmay have a hole through which lysing members may extend. As illustratedin these figures, FIG. 7 h illustrates a spacer having flat ends and acylindrical shape. FIG. 7 i illustrates a spacer having a circularcross-section and tapered ends which may be useful for allowing adesired distribution of a coating to the surface of the spacer to reducechar buildup and/or modify ease of movement of a lysing tip throughtissue. FIG. 7 j comprises various openings, such as holes, for deliveryof electrosurgical energy therethrough; this may allow for makingspacers of a non-conductive material and still deliver such energytherethrough. FIG. 7 k illustrates an alternative spacer that is arced.FIGS. 7L (resting) and 7 m (stressed) illustrate an alternative spacerhaving opposing loops with central openings configured to allow forreceipt of a wire or other lysing rod therethrough and a flexibleconnector extending between the two loops. As shown in FIG. 7 m , oncecoupled with adjacent beads (not shown), the flexible connector may bendto serve as a brace and space apart the adjacent beads. This spacer mayalso be configured such that the opposing loops may be flexed to theside to allow for coupling of adjacent beads and receipt of a lysing rodtherethrough (not shown). FIG. 7 n illustrates a cross-sectional view ofanother spacer having a triangular cross-sectional shape and an openingfor receipt of a lysing rod therethrough. FIG. 7 o illustrates across-sectional view of another spacer having a rectangularcross-sectional shape and an opening for receipt of a lysing rodtherethrough. FIG. 7 p illustrates a cross-sectional view of anotherspacer having a pentagonal cross-sectional shape along its length and anopening for receipt of a lysing rod therethrough while FIG. 7 pxcomprises a spacer having a pentagonal cross-section that is twistedalong its length and an opening for receipt of a lysing rodtherethrough. Spacers with twisted features may acquire less debrisalong its surface and may tend to rotate thus multiple sides of a spacerare exposed to charred tissue. FIG. 7 q illustrates a cross-sectionalview of another spacer having a hexagonal cross-sectional shape and anopening for receipt of a lysing rod therethrough. FIG. 7 r illustrates ablade-style cross-sectional shape with smooth, rounded outer surfacesthat meet at the distal edge and an opening for receipt of a lysing wireor other lysing rod therethrough. FIG. 7 s illustrates a cross-sectionalview of another spacer having a blade cross-sectional shape (differingfrom FIG. 7 r in that outer surfaces are formed by intersectingplanar/flat surfaces) and an opening for receipt of a lysing wire orother lysing rod therethrough. FIG. 7 t illustrates a cross-sectionalview of another spacer having a spindle cross-sectional shape and anopening for receipt of a lysing wire or other lysing rod therethrough.

The cross-sectional shape of the exterior surface of spacers may also beimportant as to the most efficient and safe means to transferelectrosurgical energy from spacers to the tissue(s). Electrosurgicalenergy on/under a surface may tend to move toward edges of an object, soa spacer with an exterior surface having a circular cross section mayforce current to the opposing spacer ends creating hot spots at/nearadjacent beads. Therefore, it may be beneficial for spacers to comprisean exterior surface having a non-circular cross section with one or moresubstantially uniform edges along its length from which electrosurgicalenergy may uniformly be transferred to tissues. In contemplatedembodiments, a pentagonal or hexagonal cross-sectional shape may bepreferable. Additionally, spacers with non-circular cross-sections mayaccumulate less debris and/or eschar on lysing rod and/or spacer becausedebris may have a more difficult time adhering to an angled edge. Insome embodiments, one or more (in some embodiments, all) of the spacersmay comprise a leading edge for delivery of electrosurgical energy fromthe lysing member(s). In some such embodiments, one or more of thespacers may comprise only a single such leading edge. In some suchembodiments, the spacer(s) may comprise a smooth, or at leastsubstantially smooth, exterior surface, other than the single leadingedge. For example, the spacer(s) (or, in some embodiments, the lysingmember/rod itself) may comprise a circular or oval shape in crosssection with a flattened leading end terminating in a leading edge. Thismay be useful for controlling the delivery of electrosurgical energy.

Because the spacers may be configured to receive the lysing member/rodtherethrough, the spacers may also comprise an opening extendingtherethrough for receiving the lysing member/rod. Thus, the spacers mayalso have an interior cross-sectional shape, which may differ from theshape of the exterior surface. For example, it may be useful to form thespacers with an opening having a cross-sectional shape that matches thecross-sectional shape of the lysing member/rod. Thus, if the lysingmember/rod comprises a circular or polygonal shape in cross-section, thespacer(s) may comprise an opening having a similar cross-sectionalshape. In some embodiments, the shape of the exterior surface of thespacers may therefore be used to primarily dictate preferred deliverylocations for the electrosurgical energy.

FIGS. 7 aa-7 zzz show alternative shapes for beads positioned along alysing tip. As illustrated in these figures, bead shapes that may beuseful may include spheres (FIG. 7 aa), wheel shapes (FIG. 7 bb),dodecahedron shapes (FIG. 7 cc). In other embodiments, bead shapes maybe bullet-shaped or partially or substantially ellipsoidal (FIGS. 7 dd-7ff) and may have facets (FIGS. 7 ee and 7 ff). In other contemplatedembodiments, beads of various geometries may be cut off having flat orslightly curved proximal surfaces or further shaped by geometric cuts(FIGS. 7 gg-7LL) (herein, this may be referred to as “frusto-shaped”).In other contemplated embodiments, bead shapes and/or tunnels throughthem may be uniform spherical and/or centered. In other contemplatedembodiments, beads may have skeleton features supported by a hub thatmay be adjacent to the lysing rod or adjacent to or formed around aceramic sleeve through which a lysing rod is extended (FIGS. 7 mm-7 rr).In some contemplated embodiments, providing a rough trailing end maycreate frictional drag on that portion of the bead thus helping reorientthe front end of the bead for further tissue passage. Thus, in someembodiments, the trailing end may have a rougher surface than the frontend. For example, in some embodiments, the trailing end, or at least aportion of the trailing end, of one or more beads may be sanded with arougher sanding material than the leading end, may be formed withridges, grooves, or other roughening elements, or may otherwise be madewith a less smooth surface for this purpose. In some contemplatedembodiments such as that depicted in FIG. 7 rr, a bead may comprise aslot beginning at its trailing end and terminating within the bead 7 rrso as to allow for receipt of a lysing rod therein. In some suchembodiments, a hole 755 may be positioned to extend through the bead andmay at least partially intersect with slot 753. Thus, a weld, plug,glue, insert or other method of fixation may be inserted via hole 755 toattach to a lysing rod thus restricting movement of a bead and/orrotation of the bead with respect to its lysing rod.

In alternative embodiments, beads may comprise a conductive materialsuch as metal and coated with an insulator; for example, a bead shapedsuch as FIG. 7 rr but made of metal (internally) may be pressed over alysing rod with increased pressure closing the slot behind the lysingrod causing the bead to remain in place along a lysing rod.

In alternative embodiments such as in FIGS. 7 ss-7 vv, beads may beflattened, curved, hollowed-out or distorted in one or more axis. Curvedbeads such as those depicted in FIGS. 7 xx and 7 yy may allow forredirection of the tip in various tissues. As well, flattened beads,such as those in FIG. 7 ww or other shapes depicted herein, may betilted or bound on one or more axes that redirect the angle of attackand/or tissue passage to an angle different than the primary axis of theshaft of a lysing tip or the guiding shaft coupled to the lysing tip.

In still other embodiments, beads with shapes as those depicted in 7 zzzand 7 zz may comprise surface regularities or one or multiple surfaceirregularities, respectively.

In still other embodiments, a particular lysing tip may comprise one ormore bead shapes.

FIGS. 8 a-8 b depict an embodiment of a system 800 and illustrate someof the steps involved in an implementation for introducing detachablelysing tip 810 into the body with grasping/control instrument 890 and/ortransfer/grasping instrument 896 by way of cannula 832, which may be atrocar. Transfer/grasping instrument 896 may be delivered by way of asecond cannula 835. As depicted in FIGS. 8 a-b , lysing tip 810 may bedelivered through a first/primary cannula 832, which may comprise, forexample, a trocar, and then coupled with a first surgical tool, such asa grasping/control instrument 890 that can be used to control and/orenergize the lysing tip 810 within the body of a patient during asurgical procedure. In some embodiments and implementations, a secondcannula 835 may be used to deliver a second surgical tool, such as atransfer/grasping instrument 896, that may be used to facilitatecoupling of lysing tip 810 to the grasping/control instrument 890, whichinstrument may be delivered through the same cannula 832 through whichthe lysing tip 810 is delivered. In some embodiments, grasping/controlinstrument 890 may have the same configuration as grasping/transferinstrument 896. In alternative embodiments, transfer/grasping instrument896 may be configured differently from grasping control instrument 890in that, for example, it may not have the capability to transfer energyto lysing tip 810 and/or may have a different jaw and/or tip design inorder to facilitate grasping/holding lysing tip 810 between two beads orother protrusions. Alternatively, the lysing tip 810 may be deliveredthough a second unattached cannula 835 along with a grasping/transferinstrument 896 used to couple the lysing tip 810 to the first surgicaltool delivered through the first/primary cannula, which other surgicaltool may be used to control lysing tip 810 and perform the surgicalprocedure. As shown in the FIG. 8 a , lysing tip 810 is positionedwithin outer cannula 832 with an axis extending between the beads 851 inlysing tip 810 aligned with a primary axis of cannula 832 and with atreatment side of lysing tip 810 facing an internal surface of cannula832.

In some implementations of methods using system 800, the lysing tip maybe reconfigured from a delivery configuration to a treatmentconfiguration by delivering lysing tip 810 through a cannula at leastsubstantially along a treatment axis of the lysing tip extending betweenopposing outer beads and then rotating the lysing tip once outside thedistal end of the cannula. In some such implementations, the step ofreconfiguration of the lysing tip from delivery to treatmentconfiguration may further comprise grasping a portion of the lysing tipin a manner such that the lysing tip axis is at least substantiallyperpendicular to an axis of the grasping instrument.

As also depicted in FIGS. 8 a and 8 b , lysing tip 810 further comprisesa grasping tab 860 t coupled to the lysing rod 860 of lysing tip 810. Insome embodiments, grasping tab 860 t may be configured to facilitatetransfer of lysing tip 810 from a delivery to a treatment configurationby being configured for being grasped by instrument 896 after lysing tip810 has been advanced through the distal opening of cannula 832. Inpreferred embodiments, grasping tab 860 t may be configured dissolveand/or biodegrade upon application of electrosurgical energy to lysingrod 860. For example, grasping tab 860 t may comprise a biodegradablesubstance which may also comprise absorbable suture, gelatin, wax,polyglycaprone, polyglycolic acid, polylactic acid, and/orpolydioxanone. While opposing grasping instrument 896 is temporarilygrasping tab 860 t, the jaws of the treatment/grasping instrument 890may lock down on the desired portion of the lysing rod 860 and/oranother portion of lysing tip 810. Once the device is electrosurgicallyactivated and discharges energy and significant temperatures aregenerated, the tab 860 t may be configured to melt or decompose thusexposing the desired portions of lysing rod 860 so treatment maycommence. Once the tab 860 t has been melted or otherwise removed fromlysing rod 860, preferably tab 860 t is bioresorbable and/orbioabsorbable and therefore need not be removed from the body followingthe procedure.

In alternative implementations, a standard 3-5 mm diameter graspinginstrument with handle (without a lysing tip attached) may be directedinto the body cavity, possibly via a trocar of accepting diameter or viaan incision in the skin, and exit extracorporeally via another trocar(for example, of larger diameter at umbilicus), whereupon the graspermay open and receive the lysing tip at an angle that permits the grasperto pull lysing tip into the body cavity through the larger trocar. Onceinside the body cavity, the lysing tip may be reconfigured from adelivery configuration to a treatment configuration.

In alternative embodiments, the transfer grasping instrument maycomprise at the distal end other means for grasping the lysing tip 810such as a hook and/or magnet and/or glue.

An alternative system for use of a lysing tip 814 t with a modulargrasping instrument tip 814 g is shown in FIGS. 8 c and 8 d . In someembodiments, modular instrument tip 814 g and lysing tip 814 t may bepermanently coupled to one another as described below. Alternatively, inother embodiments, lysing tip 814 t may be removable from modularinstrument tip 814 g. When the instrument tip 814 g and lysing tip 814 tmay be combined, they may be referred to herein as a modular grasper/tip814. Modular instrument tip 814 g comprises a locking lumen 897′ that isconfigured to be coupled with a distal end of a pushrod 897 and shaft896 of a modular grasping/control instrument 90.

In an example of a procedure using the system of FIG. 8 c , a surgeonmay initially place a trocar 832′ at a desired location such as throughan incision 6′ positioned through the umbilicus 5. A second incision 6,which may be a smaller incision than incision 6′, may be made at alocation spaced apart from incision 6′. In some embodiments andimplementations, incision 6 may be between about 2.5 and about 5 mm.Shaft 896 of instrument 90 may then be extended through incision 6 andthen subsequently through incision 6′ and trocar 832′. Modular graspinginstrument 814 g may then be coupled with the distal end of shaft 896and push rod 897. Once lysing tip 814 t is coupled with modular graspinginstrument tip 814 g, instrument 90 may then be pulled proximally tointroduce lysing tip 814 t within patient 4. In embodiments in whichlysing tip 814 t is removable from modular grasping instrument tip 814g, lysing tip 814 t may be coupled with the distal end of instrument tip814 g prior to proximally pulling instrument 90 and its distal tip backinto the cavity of human or animal body 4. Once modular instrument tip814 g has been coupled with instrument 90, handle 91 may be used tocontrol one or more aspects of lysing tip 814 t. For example, actuationof handle 91 may result in locking lysing tip 814 t at a particularrotational orientation relative to shaft 896. Alternatively, handle 91or another actuation element of instrument 90 may be used to rotatelysing tip 814 t between delivery and treatment configurations.Instrument 90 may also be used to deliver electrosurgical energy tolysing tip 814 t. For example, as shown in FIG. 8 c , energy connector92, which may comprise a conductive post may be used to facilitate anelectrical connection with an electrosurgical generator. Theelectrosurgical energy from this generator may extend through shaft 896via pushrod 897 and be coupled with one or more lysing members of lysingtip 814 t, as previously described.

FIG. 8 d depicts a more detailed view of the interface between modulargrasping instrument 814 g and distal tip of shaft 896 and pushrod 897 ofinstrument 90. As shown in this figure, the distal end of shaft 896 maycomprise a locking feature 898. Locking lumen 897′ within modularinstrument tip shaft 894 comprises a slot 899 s configured to receivelocking feature 898 at a predetermined rotational configuration. Uponaligning locking feature 898 with slot 899 s, shaft 896 and pushrod 897may be advanced into locking lumen 899′. After advancing shaft lockingfeature 898 to its terminal end 898′ within coupling rod 892, uponrotation 2 of modular instrument tip shaft 894, locking feature 898securely couples shaft 896 to coupling rod 892. During the same timeperiod, pushrod 897 and its accompanying pushrod locking feature 899 nwas advanced to a locking chamber 899 n′ in which pushrod 897 and itsaccompanying pushrod locking feature 899 n may have been rotated to lockpushrod locking feature 899 n in place within locking chamber 899 n′.Locking feature 899 n preferably comprises a flattened or otherwiseasymmetrical piece such that rotation of shaft 896 may result in lockingfeature 899 n engaging a ledge or other locking feature of lockingchamber 899 n′. In some embodiments, the extent of the rotation ofpushrod locking feature 899 n may be the same as the extent of rotationof locking feature 898 which may, in some embodiments, be 90 degrees. Insome embodiments, pushrod locking feature 899 n may comprise a plate oran elongated box or any other feature not having rotational symmetryabout the axis pushrod 897. Locking chamber 899 n′ may comprise, forexample, a box or other similar feature given to engage pushrod lockingfeature 899 n upon rotation of pushrod 897.

Locking chamber 899 n′ is coupled with coupling rod 892 which in turnmay be coupled with one or both jaws. Thus, upon advancing or retractingpushrod 897, coupling rod 892 advances or retracts to open or close thejaws so as to capture support member 870 within jaws 893 b.

Any of the systems discussed herein may be configured to have theircorresponding lysing tips delivered into the body in one or more of themethods described above.

FIGS. 9 a -9L depict an alternative embodiment of a CDTD system 900comprising a plurality of protrusions 901 defined by beads 951 and jawcovers 993 aa/994 aa and recessions 902 positioned in between adjacentbeads 951 and jaw covers 993 aa/994 aa. System 900 comprises bipolarelectrosurgical system. System 900 is configured for bipolarelectrosurgical energy delivery and comprises lysing tip 910 that mayhave 3 protrusions defined by two outer beads 951 and the tip of alaparoscopic grasping instrument simulating the geometry of a middlebead, and 2 lysing segments 961 cn/961 cp defined by two electricallyisolated lysing members 961 p/961 n

An electrosurgical grasping/control instrument 991 may be used todeliver electrosurgical energy to lysing tip 910 and control lysing tip910 during a surgical procedure. Instrument 991 may comprise one or morepush rods 992 that may be used to control one or both jaws 993 and 994and/or deliver electrosurgical energy into tip 910. As previouslydescribed, jaws 993 and 994 may each comprise a conductive core ortongue 993 a′/994 a′ and an insulting cover 993 aa/994 aa. One or bothof upper and lower jaw covers 993 aa and 994 aa may comprise anelectrosurgical energy transfer opening configured to allow for contactwith conductive portions of tip. These portions may be of oppositepolarity and electrically isolated from each other along their paths.This may require that the entire housing and core components of, forexample, the upper jaw be made of a ceramic or other non-conductor withperhaps the use of a wire lead that would be electrically isolated fromthe connected to the upper jaw electrosurgical energy transfer opening987. For example, energy may flow from the electrosurgical energytransfer opening 987 of the lower jaw into the lysing segment on theside contacting the lower jaw 961 n; energy then flows from the lysingsegment 961 n into the target tissues cutting and/or coagulating thetarget tissues and energy returns into the opposite side lysing segment961 p and into the, for example, electrosurgical energy transfer opening987 of upper jaw assembly 993 and then to its electrically isolated leadand back to the electrosurgical generator.

As depicted in FIG. 9 e , lysing tip 910 may comprise a bar or plateregion 956 between opposing beads to support the beads from the sides.This region may comprise opposing wings 956 w defined in part by acentral grasping pad 956 g that may be recessed from opposing wings 956w. Grasping pad 956 g may be configured to be engaged by one or bothjaws 993/994. Preferably, the entire portion of tip 910 depicted in FIG.9 e is made up of a ceramic or other non-conductive material. In someembodiments, beads 951 may be coupled with the central portion of lysingtip 910. Alternatively, beads may be formed so as to be an integral partof the non-conductive portion of lysing tip 910.

Isolated conductive lysing members 961 p and 961 n, as shown in FIGS. 9f and 9 g , may be positioned within the portion of tip 910 depicted inFIG. 9 e to define a complete lysing tip. As shown in FIG. 9 e , slots956 sn and 956 sp may be provided in lysing tip 910 to allow the lysingedges 961 cn and 961 cp of lysing members 961 p and 961 n to protrudefrom the non-conductive body of lysing tip 910 and define lysingsegments. In addition, openings may be provided in the non-conductivebody to allow for receipt of electrosurgical energy into lysing members961 p and 961 n. More particularly, as shown in FIG. 9 e , an upperopening 956 hp may be provided in the upper portion of grasping pad 956g, through which a projection and/or prong, such as terminal post 961tp, of lysing member 961 p, may extend. Although not visible in FIG. 9 e, a similar opening may be formed in the lower surface of grasping pad956 g for receipt of terminal post 961 tn of lysing member 961 n.Contact between these various posts and conductive jaw tongues throughopenings in a non-conductive portion of lysing tip 910 can be seen inFIGS. 9 h -9L.

Preferably, the respective terminal posts or other projections of thelysing members protrude beyond the opposing surfaces of grasping pad 956g to allow them to make contact with a conductive portion of opposingjaws 993/994, such as conductive tongues 993 a′/994 a′. As previouslymentioned, openings 987 may be formed in jaw covers 993 aa/994 aa toallow for such contact. In addition, slots 997 may be formed in the jawcovers of upper and lower jaws 993 and 994 to allow for grasping pad 956g to fit therein. Slots 997 may be formed so as to partially defineopenings 987 as shown in FIG. 9 I.

FIGS. 9 j and 9 k depict two cross sectional views of system 900 in adirection along the axis of grasping control instrument 990, one at thecenter of terminal post 961 tp and the other at the center of terminalpost 961 tn respectively. FIG. 9 j shows terminal post 961 tp contactingupper jaw tongue 993 a′ while FIG. 9 k shows terminal post 961 tncontacting lower jaw tongue 994 a′.

A non-conductive cover or sleeve 995 may be positioned on a distalportion of instrument 991 in some embodiments, as shown in FIG. 9 a.

The relative static permittivity of some ceramics may range from about 5to 10; this may cause some leakage of current in an undesirable pathbetween closely approximated opposing electrodes during activation. Useof other materials, for example, those having over of relative staticpermittivities of 5 may undesirably alter the resultant plasma field.The relative static permittivity of the intervening materials housingthe opposing electrodes may be enhanced by coating and/or surroundingand/or injection molding thermoresistant polymers of a low relativestatic permittivity into the housing and/or around one or more portionsof bipolar lysing segments 961 n/961 p to reduce the effective staticpermittivity of the tip. In an embodiment, the thermoresistant polymerof low relative static permittivity 2.1 may be polytetrafluoroethylene.In other contemplated embodiments, thermoresistant polymers may includepolyether etherketone (@3.3) and/or polysulfone (@3.1) and the like maybe useful.

In the depicted embodiments, electrical insulator to isolate one or morecomponents or the electrical path to and from the electrosurgicalgenerator may comprise polytetrafluoroethylene. In other contemplatedembodiments, the electrical insulator may comprise an electricallynonconductive polymer with a high melting temperature. In someembodiments, the nonconductive polymer may comprise for example,polyether etherketone and/or polysulfone, etc. In other contemplatedembodiments, the electrical insulator may comprise an electricallynonconductive and/or thermally nonconductive polymer.

As of the year 2000, the bipolar mode had traditionally been usedprimarily for coagulation (reference: “The Biomedical EngineeringHandbook, Electrosurgical Devices” J Eggleston, W Maltzahn, Ch 81, CRCPress 2000). However, more recent modifications to bipolarelectrosurgical outputs may have facilitated the use of bipolar cuttinginstruments (reference: ValleyLab, Hotline, vol. 4, issue 4 pg. 1),examples of such outputs may include Macrobipolar settings (Reference:ValleyLab ForceTriad Users Guide 2006, chapter/sections: 9-13, 9-16,9-24).

After application of the TD and/or Heater to the cellulite treatmentzone, within approximately 2 to 8 months, the surgeon may inject fluid,including but not limited to tumescent fluid, into and around thetreatment zone to stretch the previously treated area. Inflating thetreatment zone with fluid and/or gas may tend to separate, stretch, ordeform unwanted tendrils or deposits that may be tending to reform orreorganize in the post-surgical treatment zone. The amount of fluidneeded may vary from 0.5 cc to 2.0 cc per sq. cm. Even larger amounts offluid per sq. cm may be administered depending upon the clinicalsituation as perhaps the greater the stretch, the longer the duration ofsurgical result. The fluid may be administered by injection needle,spatula cannula, or any suitable percutaneous device. It may bedesirable to have a long injection system for example a 40 cm longspatula cannula so that the entrance wound for the cannula may be placedin a non-conspicuous location. The fluid may be administered underpressure as well via peristaltic pump, elevated IV bag, or mechanicalinjection mechanism. The process may be repeated every 2 to 8 months,possibly indefinitely to help maintain the surgical result.

FIGS. 10 a-10 k depict an embodiment of a lysing instrument 1000.Instrument 1000 may comprise shaft 1090 and two-way lysing tip 1033.Lysing tip 1033 is configured for two-way motion (i.e., forward/distaland reverse/proximal motion) due to, as discussed below, the presence oflysing segments that face in the forward/distal direction to facilitateforward motion of lysing tip 1033 through tissue and other lysingsegments that face in the rearward/proximal direction to facilitaterearward/proximal motion of lysing tip 1033 through tissue. Shaft 1090may physically couple lysing tip 1033 to an electrosurgical energysource such as an electrosurgical pencil (not shown) via conductiveinsert 1060 s, which in the depicted embodiment comprises a conductiverod, which may be electrically conductive and act as a conduit forelectrosurgical energy to flow to lysing tip 1033. In the depictedembodiment, conductive insert 1060 s comprises an integral extensionfrom electrode 1060. In other contemplated embodiments, however,conductive insert 1060 s may be coupled to electrode 1060, eitherdirectly or indirectly such as by way of a wire or the like.

Lysing tip 1033 comprises one or more distal-facing lysing segments andone or more proximal-facing lysing segments. Each of these variouslysing segments may be defined by a single electrode or each by its ownrespective electrode. In the depicted embodiment, a single electrode1060 is used to define each of the various lysing segments and a shapednon-conductive body 1033 b is used to define various beads, protrusions,and/or other features that define recessions into which the lysingsegments are positioned. Non-conductive body 1033 b defines two (ormore, as shown in other embodiments) forward-facing distal protrusions1001 d defined by the distal tips 1051 d of beads 1051 and a distalrecession 1002 d (more than one distal recession may be provided onother embodiments) positioned between distal tips of beads 1051 d.Lysing tip 1033 may further comprise one or more rearward-facingproximal protrusion/recession lysing segments or lysing segment pairs aswell to facilitate proximal motion of the device 1000 through tissue.For example, beads 1051 further define rearward protrusions defined bythe proximal tips 1001 p of beads 1051 and recessions 1002 p defined byproximal tips 1001 p along with the shaft/neck of lysing tip 1033.

Shaped nonconductive body 1033 b may comprise one or more beads 1051that may be supported by and/or spaced by one or more rigid orsubstantially rigid struts 1080, each of which may be permanently ortemporarily coupled between adjacent beads 1051 and, in someembodiments, may be further coupled along a proximal region with theshaft of lysing tip 1033. In the preferred embodiment shown in FIGS. 10a-10 g , shaped nonconductive body 1033 b may comprise slot 1080 s thatmay extend between strut 1080. Slot 1080 s may define a distal slotopening 1080 sd defined on its upper and lower sides by strut 1080 andon its left and right sides by one or more tunnels 1051 t in beads 1051.

In this embodiment, electrode 1060 may be passed through distal slotopening 1080 sd and operationally positioned and configured for lysingsegment 1060 d, which is defined by an exposed portion of electrode1060, to face distally through distal slot opening 1080 sd and to allowfor delivery of electrosurgical energy therethrough. Shapednonconductive body 1033 b may further comprise one or more proximal slotopenings 1080 sp through which the proximal lysing segments 1060 p ofelectrode 1060 may be exposed to allow for delivery of electrosurgicalenergy therethrough and to facilitate rearward movement of lysing tip1033 through tissue.

Beads 1051 and strut 1080 may be comprised of ceramic, cermet, glass,various halogenated hydrocarbons, and any other suitable nonconductors.

As depicted in FIGS. 10 h-10 j at cross section line 10 j-10 j, in otherembodiments, beads 1051′ may not comprise any tunnels or holes, therebyeffectively narrowing slot 1080 s′ and reducing the width of the distallysing segment 1060 d′ of electrode 1060′. Lysing tip shaft 1033 s′ maydefine the medial boundaries of proximal lysing segments 1060 p′, asbest shown in FIG. 10 j.

When an electrosurgical generator is activated by a surgeon,electrosurgical energy may be transmitted through conductive insert 1060s, through shaft 1090, to electrode 1060, which activates lysingsegments 1060 d and 1060 p for delivery of electrosurgical energy intotissue.

In some embodiments, the conductive material of electrode 1060 maycomprise: steel, nickel, alloys, palladium, gold, tungsten, silver,copper, platinum and/or another conductive metal that does not give offtoxic residua at operating temperatures. In some embodiments, electrode1060 may be coated with a non-stick material which may comprise gold,silver, rhodium, titanium, titanium alloys, tungsten, certain cobaltalloys and the like, along with combinations of any of the foregoing.

In some embodiments, the width of the distal portion of lysing tip 1033(defined between the outermost portions of the outermost beads 1051) maybe between about 4 mm and about 5 mm and the length of the beads, whichmay be defined by the shaped nonconductive body 1033 b, may be betweenabout 3 and about 10 mm.

By providing both distal and proximal lysing segments for dissectionand/or coagulation of tissue in an anterograde and/or retrogradefashion, a number of benefits may be achievable. For example, theefficiency of dissection may be increased because a forward pass mayseparate tissue and moving the tip in the reverse direction alsoseparates tissue rather than merely readying the tip for another forwardpass. As another example, providing both distal and proximal lysingsegments, preferably using recessions, may reduce in the necessarywidth/size of operating tool so various models may fit down smallerdiameter cannulas and/or entrance-wounds/body-openings for minimallyinvasive surgery and/or entrance wound/scar minimization. In addition,providing for retrograde dissection may favor various dissection anglesor patterns when various force vectors are placed upon the targettissues and/or target tissue planes.

It should be understood that the embodiments disclosed herein may havevalue and application in various different types of surgery. Forexample, the lysing tips, devices, and methods disclosed herein may beuseful for cosmetic surgery, including facial dissection, neckdissection, and cellulite treatment, and may also be useful inconnection with internal surgeries, such as laparoscopic and/orendoscopic procedures. Thus, the device may be introduced directly intothe body from an opening in the skin or may be introduced using a trocarand/or cannula in other types of surgical procedures.

While the device is energized with electrosurgical energy, beads 1051and strut 1080 are preferably non-conductive in order to perform theblunt dissection function.

In some embodiments, lysing member/electrode assembly 1060 comprises arigid and/or substantially rigid plate as shown in FIG. 10 d . In suchembodiments, one or both of proximal lysing segments 1060 p and/ordistal lysing segments 1060 d may be configured to be electricallycoupled with electrode shaft 1060 s. In some such embodiments, electrode1060 may comprise a single, unitary piece of a suitable conductivematerial that serves each of these functions.

In alternative embodiments, any number of holes may be made at anynumber of angles to intersect the electrode assembly 1060 and/or itstunnel 1051 t or slot 1080 sd to deposit a material that restrains thelysing segment/electrode assembly within the beads 1051, the beadtunnels 1051 t, and/or slot 1080 (for example, materials may includewelds, glues, epoxies, plugs, and the like). In such embodiments, tunnel1051 t may be a blind tunnel not requiring full passage through bead1051. In other embodiments, tunnels 1051 t may be complete tunnels. Inalternative embodiments, beads 1051 may be replaced with beads of anyshape, including but not limited to those depicted in FIGS. 7 aa to 7zzz.

As previously mentioned, lysing tip 1033 comprises a plurality of beads1051 and a plurality of recessed lying segments that, again, may bedefined by one or more electrodes. It should be noted that in theembodiments of FIGS. 10 a-10 g , beads 1051 are supported laterallyalong their respective inner sides by strut 1080. In other words, beads1051 each define a primary and/or elongated axis extending between theirrespective distal tips and proximal tips. In the depicted embodiment,these axes extend at least substantially parallel to the axis of theinstrument 1000. Rather than being supported from behind, such as by anelement extending between the proximal ends of beads 1051, beads 1051are support along their respective sides by an element (strut 1080 inthe depicted embodiment) that extends at least substantiallyperpendicular relative to their respective primary axes so that the beadshape is still apparent from the structure of lysing tip 1033.

It should also be noted that beads 1051 lack a base, such as base 105for system 100 detailed in U.S. patent application Ser. No. 15/464,199titled “Apparatus, Systems and Methods for Minimally Invasive Dissectionof Tissues” filed on Mar. 20, 2017, which application is herebyincorporated by reference in its entirety. Thus, it should also beunderstood that beads 1051 lack structure immediately behind the beadsfor support. It should also be noted that lysing tip 1033 comprisesbeads 1051 that project both distally and proximally relative to strut1080.

Shaft 1090 may couple with tip 1033 to facilitate transfer ofelectrosurgical energy in a desired manner and/or allow for manuallydissection in the absence of electrosurgical energy. Shaft 1090 may bedeformable, that is, it may be bent so as to angle the lysing tip in adesired direction, for example, to ensure the lysing tip is angled up by3 to 10 degrees so as to direct cutting/lysing towards the dermis of theskin in a cosmetic procedure.

It should also be noted that beads 1051 may, on the same instrument, beof the same shape, may be of different shapes, and/or may be angled upor angled down by, for example, between about 3 to about 15 degrees toassist in guiding the tip towards the upper or lower tissue plane. Inother embodiments, each bead may be angled in a different direction asdesired in accordance with the anticipated use of the device. In theseembodiments, strut 1080 may remain parallel to the top and/or bottomsurfaces of the device or may follow the same angle as its respectivebead.

Shaped nonconductive body 1033 b may comprise one or more sensoropenings 1070 and 1070 a (only shown on FIGS. 10 a and 10 c ) which mayserve as locations for various sensors including but not limited totemperature sensors, fiberoptics, positioning sensors, RFIDsensors/tags, and the like. Sensor openings 1070 and 1070 a may beconnected to one or more ducts that may pass through shapednonconductive body 1033 b and exit on the proximal end of lysing tip1033. Alternatively, sensors positioned in sensor openings 1070 and 1070a may be configured to deliver data wirelessly. It should be noted thatsensor 1070 a is located on the distal end of bead 1051; a sensorlocated in opening 1070 a may be used to measure temperature during theinstrument's back stroke because the treated tissue would typically passadjacent to this sensor 1070 a during a back stroke. In someembodiments, a temperature or other sensor measurement may be takenduring an RF activation or between RF pulses. In alternativeembodiments, the sensor exposed at sensor opening 1070 a may be afiberoptic that may sense tissue color and/or the presence of blood.

While instrument 1000 is energized with electrosurgical energy, beads1051 and strut 1080 are preferably non-conductive, thus minimizingunwanted electrical discharge. The electrically conductive electrode1060 may be configured to deliver electrosurgical energy through thevarious distal and/or proximal lysing segments, as previously mentioned.

Beads 1051 and strut 1080 may be comprised of ceramic, cermet, glass,various halogenated hydrocarbons, and any other suitable nonconductors.Beads 1051 may be restricted in their motion and/or affixed to strut1080 via direct coupling (i.e., continuous/integral ceramic) and/orconductive materials such as those that comprise electrode 1060. Aswell, indirect sealing methods such as epoxy or ceramic glues or pottingmixes and the like may be used to seal any unwanted seams or openings tomaintain non-conductive integrity in the desired locations. When anelectrosurgical generator is activated by a surgeon, electrosurgicalenergy may be transmitted through any suitable electrical couplingelements to electrode 1060.

In still another embodiment depicted in FIGS. 10 k -L, at the crosssection of Line 10 k-10 k set forth in FIG. 10 i , electrode 1063 may bemodified with nonconductive lip 1063L that is intended to be positionedadjacent to the border created by the edges of strut (not shown) and theedges of beads 1053 and bead tunnels 1053 t, if present. Nonconductivelip 1063L may then define or substantially define distal lysing segment1063 d. Nonconductive lip 1063L may assist in sealing the internalcomponents from liquid intrusion, minimize the unwanted escape of RFenergy, and/or reduce the surface area of lysing segment exposure.Nonconductive lip 1063L may be composed of various materials that adhereto conductors and/or may be a suitable dielectric, for example, aceramic or porcelain material.

FIGS. 11 a-11 e depict an embodiment of a lysing instrument 1100.Instrument 1100 may comprise shaft 1190 and two-way lysing tip 1133.Lysing tip 1133 is configured for two-way motion (i.e., forward/distaland reverse/proximal motion) due to, as discussed below, the presence oflysing segments that face in the forward/distal direction to facilitateforward motion of lysing tip 1133 through tissue and other lysingsegments that face in the rearward/proximal direction to facilitaterearward/proximal motion of lysing tip 1133 through tissue. Therearward/proximal lysing segments of instrument 1100 extend, as shown inthe figures, at least substantially perpendicular to the shaft 1190 ofinstrument 1100. In the depicted embodiment, both the distal andproximal lysing segments define concave curves. However, both of thepoints at which these lysing segments terminate (at or adjacent to abead on one end and at or adjacent to shaft 1190 at the opposite end)define a line that is perpendicular, or at least substantiallyperpendicular, to shaft 1190 and/or the primary/elongated axes of thebeads themselves. Similarly, at a central or at least substantially acentral point along each of the lysing segments between the twotermination points previously referenced, a tangent line to thiscurvature is perpendicular, or at least substantially perpendicular, toshaft 1190 and/or the primary/elongated axes of the beads. Thus, despitethe curvature of the depicted lysing segments, they should each beconsidered to extend at least substantially perpendicular to the shaft1190 of instrument 1100, and at least substantially perpendicular to theelongated and/or primary axis of beads 1151. These aspects of the lysingsegments may apply to any of the other embodiments depicted and/orotherwise disclosed herein.

However, other embodiments are contemplated in which these lysingsegments may extend at another angle relative to the shaft 1190 and/orprimary axis of instrument 1100. For example, in other embodiments, theproximal/rearward lysing segments may extend at an angle of betweenabout 60 degrees and about 120 degrees from the shaft 1190 and/orprimary axis of instrument 1100. Shaft 1190 may physically couple lysingtip 1133 to an electrosurgical energy source such as an electrosurgicalpencil (not shown) via conductive insert 1160 s, which in the depictedembodiment comprises a conductive rod, which may be electricallyconductive and act as a conduit for electrosurgical energy to flow tolysing tip 1133. In the depicted embodiment, conductive insert 1160 scomprises an integral extension from electrode 1160. In othercontemplated embodiments, however, conductive insert 1160 s may becoupled to electrode 1160, either directly or indirectly such as by wayof a wire or the like.

Lysing tip 1133 comprises one or more distal-facing lysing segments andone or more proximal-facing lysing segments. Each of these variouslysing segments may be defined by a single electrode or each by its ownrespective electrode. In the depicted embodiment, a single electrode1160 is used to define each of the various lysing segments, includingboth the distal facing lysing segments that are configured to facilitateforward/distal motion of instrument 1100 and the proximal-facing lysingsegments that are configured to facilitate rearward/proximal motion ofinstrument 1100. A non-conductive body 1133 b may be used to definevarious beads, protrusions, and/or other features that define recessionsinto which the lysing segments are positioned. In some embodiments, therecessions may be defined by beads, struts, and/or lysing segments.Non-conductive body 1133 b defines three forward-facing distalprotrusions 1101 d defined by the distal tips 1151 d of beads 1151 andnose 1136 of shaft 1190 and distal recessions 1102 d (more than onedistal recession may be provided on other embodiments) positionedbetween distal tips of beads 1151 d and nose 1136. Lysing tip 1133 mayfurther comprise one or more rearward-facing proximalprotrusion/recession pairs as well to facilitate proximal motion of thedevice 1100 through tissue. For example, beads 1151 further definerearward protrusions defined by the proximal tips 1101 p of beads 1151and recessions 1102 p defined by proximal tips 1101 p of beads 1151along with struts 1180.

Shaped nonconductive body 1133 b may comprise one or more beads 1151that may be supported by and/or spaced by one or more rigid orsubstantially rigid struts 1180, each of which may be permanently ortemporarily coupled between adjacent beads 1151 and/or between an outerbead and the nose 1136 and/or shaft 1190 or shaft portion of lysing tip1133. In some embodiments, struts 1180 may be further coupled along aproximal region with the shaft of lysing tip 1133. In the preferredembodiment shown in FIGS. 11 a-11 e , shaped nonconductive body 1133 bmay comprise one or more slots 1180 s that may extend along each strut1180. Slot(s) 1180 s may define a distal slot opening 1180 sd defined onits upper and lower sides by struts 1180 and/or nose 1136 and on itsleft and right sides by one or more beads 1151.

In this embodiment, electrode 1160 may be passed through distal slotopening 1180 sd and operationally positioned and configured to definedistal lysing segments 1160 d, which may be defined by exposed portionsof electrode 1160 on either side of nose 1136, to face distally throughdistal slot opening 1180 sd and to allow for delivery of electrosurgicalenergy, or another type of suitable energy for modification of tissue,therethrough. Shaped nonconductive body 1133 b may further comprise oneor more proximal slot openings 1180 sp through which proximal lysingsegments 1160 p of electrode 1160 may be exposed to allow for deliveryof electrosurgical energy therethrough and to facilitaterearward/proximal movement of lysing tip 1133 through tissue.

In the depicted embodiment, specifically FIG. 11 c , an exploded viewshows how electrode 1160 may be inserted into distal slot 1180 sd whichmay also receive nose 1136 therein, which may be bonded or otherwisefixed in place to finalize the assembly.

In other embodiments such as in FIG. 11 f , the nose defining the centerprotrusion may be manufactured to receive a nose insert 1136′ therein,which may be coupled in place via a coupling agent such as a ceramicglue, fastener, or the like. In still other embodiments, nose insert1136′ (the volume between the upper portion of the nose and the lowerportion of the nose) may be filled with a filling agent, such as a hightemperature epoxy or the like.

Shaped nonconductive body 1133 b may comprise one or more sensoropenings 1170 a, 1170 b, and 1170 c (shown only in FIG. 11 b ) which mayserve as locations for various sensors including but not limited totemperature sensors, fiberoptics, positioning sensors, RFIDsensors/tags, and the like. Sensor openings 1170 a, 1170 b, and 1170 cmay be connected to one or more ducts that may pass through shapednonconductive body 1133 b and exit on the proximal end of lysing tip1133. Alternatively, sensors positioned in said sensor openings may beconfigured to deliver data wirelessly. It should be noted that sensoropening 1070 b may be located on the distal end of bead 1151. Inaddition, a sensor may be located in nose sensor opening 1170 c. Sensorslocated in openings 1170 b and 1170 c may be used to measure temperatureduring the instrument's back stroke. In some embodiments, saidmeasurement may be taken during an RF pulse or between RF pulses. Inalternative embodiments, the sensor exposed at any sensor opening may bea fiberoptic that may sense tissue color and the presence of blood.

Beads 1151, nose 1136, and/or strut 1180 may be comprised of ceramic,cermet, glass, various halogenated hydrocarbons, and any other suitablenonconductors.

As depicted in FIGS. 11 g-11 h , in other embodiments, beads 1151′ maynot comprise any tunnels or holes 1151 t, thereby effectively narrowingthe required length of slot(s) 1180 s′ and reducing the correspondingwidth of the distal lysing segments 1160 d′ of electrode 1160′ exposedby slot(s) 1180 s′. Lysing tip shaft 1133 s′ may define the medialboundaries of proximal lysing segments 1160 p′, as shown in FIG. 11 h.

When an electrosurgical generator is activated by a surgeon,electrosurgical energy may be transmitted through conductive insert 1160s, through shaft 1190, to electrode 1160, which activates lysingsegments 1160 d and 1160 p for delivery of electrosurgical energy intotissue.

In some embodiments, the width of the distal portion of lysing tip 1133(defined between the outermost portions of the outermost beads 1151) maybe between about 6 mm and about 12 mm and the length of the beads, whichmay be defined by the shaped nonconductive body 1133 b, may be betweenabout 3 and about 10 mm.

It should be noted that in being able to dissect in forward and backwarddirections, lysing tips 1033 and 1133 uniquely may be more efficientthan single direction lysing tips. Retrograde dissection may alsofacilitate use of alternative tissue tension force vectors adjacent tothe target tissues and/or target tissue planes. Tissue tension forcevectors may be applied by surgical assistants and/or the surgeon'snon-instrument hand. As well, retrograde dissection may allow foralternative dissection angles.

While the device is energized with electrosurgical energy, beads 1151,nose 1136, and strut 1180 are preferably non-conductive in order toperform the blunt dissection function. However, in some embodiments, oneor more of these elements may comprise a conductive core and anon-conductive coating or shell.

In some embodiments, lysing member/electrode assembly 1160 comprises arigid and/or substantially rigid plate as shown in FIG. 11 c . In suchembodiments, one or both of proximal lysing segments 1160 p and/ordistal lysing segments 1160 d may be configured to be electricallycoupled with electrode shaft 1160 s. In some such embodiments, electrode1160 may comprise a single, unitary piece of a suitable conductivematerial that serves each of these functions. Slot 1180 sd may beconfigured so as to tightly receive lysing member electrode assembly1160 so as to prevent or at least inhibit movement or unwanted RF energyescape. As previously mentioned, lysing tip 1133 may comprise aplurality of beads 1151 and a plurality of recessed lying segments that,again, may be defined by one or more electrodes. It should be noted thatin the embodiments of FIGS. 11 a-11 h , beads 1151 are supportedlaterally along their respective inner sides by strut 1180. It shouldalso be noted that beads 1151 lack a base, such as base 105 for system100 detailed in U.S. patent application Ser. No. 15/464,199 titled“Apparatus, Systems and Methods for Minimally Invasive Dissection ofTissues” filed on Mar. 20, 2017, which application is herebyincorporated by reference in its entirety. Thus, it should also beunderstood that beads 1151 lack structure immediately behind the beadsfor support. It should also be noted that lysing tip 1133 comprisesbeads 1151 that project both distally and proximally relative to strut1180.

Shaft 1190 may couple with tip 1133 to facilitate transfer ofelectrosurgical energy in a desired manner and/or allow for manuallydissection in the absence of electrosurgical energy. Shaft 1190 may bedeformable, that is, it may be bent so as to angle the lysing tip in adesired direction, for example, to ensure the lysing tip is angled up by3 to 10 degrees so as to direct cutting/lysing towards the skin in acosmetic procedure.

While system 1100 is energized with electrosurgical energy, beads 1151and strut 1180, or at least a portion thereof (such as surfaces otherthan those exposed for defining/exposing lysing segments), arepreferably non-conductive, thus minimizing unwanted electricaldischarge. The electrically conductive electrode 1160 may be configuredto deliver electrosurgical energy through the various distal and/orproximal lysing segments, as previously mentioned.

In some embodiments, the conductive material of electrode 1160 maycomprise: steel, nickel, alloys, palladium, gold, tungsten, silver,copper, platinum and/or another conductive metal that preferably doesnot give off toxic residua at typical operating temperatures. In someembodiments, electrode 1160 may be coated with a non-stick materialwhich may include gold, silver, rhodium, titanium, titanium alloys,tungsten, certain cobalt alloys and the like.

Beads 1151, nose 1136, and strut 1180 may be comprised of ceramic,cermet, glass, various halogenated hydrocarbons, and any other suitablenonconductors. Beads 1151 may be restricted in their motion and/oraffixed to strut 1180 via direct coupling (i.e., continuous/integralceramic) and/or conductive materials such as those that compriseelectrode 1160. As well, indirect sealing methods such as epoxy orceramic glues or potting mixes and the like may be used to seal anyunwanted seams or openings to maintain non-conductive integrity in thedesired locations. When an electrosurgical generator is activated by asurgeon, electrosurgical energy may be transmitted through any suitableelectrical coupling elements to electrode 1160.

It should also be noted that beads 1151, on the same instrument, may beof the same shape, may be of different shapes, and/or may beangled/tilted up or angled/tilted down by between about 3 to about 15degrees to assist in guiding the tip towards the upper or lower tissueplane. In other embodiments, each bead may be angled in a differentdirection. In some embodiments, strut 1080 may remain parallel to theupper and/or lower surfaces of the device or strut 1080 may follow thesame angle as its respective tilted bead such as that of bead 1154coupled with bent/angled shaft 1134 depicted in FIG. 11 i.

In another embodiment, lysing tip 1133 may be configured to oscillate invarious planes which may assist in reducing eschar buildup and may aidin the movement of lysing tip 1133 through tissues with mechanicalenergy. In this embodiment, shaft 1190 may comprise a piezoelectric oroscillating/vibrating motor unit 1199, which may be placed in the handleor at another point between the handle and the distal tip wherein thenecessary harmonic motion is created. High energy frequencies, like inthe ultrasound regions, may be chosen but may be too powerful for amulti-component device. However, lower frequencies with lower energy,similar to those used in toothbrushes to aid in cleaning, may providethe necessary energy to reduce eschar and assist in lysing. Lowerfrequencies may be possible by use of a voice coil, however,piezoceramics may be preferred. Higher frequency in the ultrasound rangerequires a smaller piezo. Said frequency range may be from about 1 kHzto about 80 kHz, with a preference for between about 21 to about 40 kHz.A hard-ceramic type piezoceramic motor may be preferred, and for lowerexcursion, the type could be expanded to include Navy Type I,exemplified by APC 840.

FIG. 12 and FIGS. 13 a-c depict a 2-bead lysing instrument 1200 and a3-bead lysing instrument 1300, respectively. Instruments 1200 and 1300both comprise a lysing tip 1233/1333, respectively.

Lysing tip 1233 comprises a conductive, unibody core 1260 (shown in FIG.12 at the cut-away window through the nonconductive layer), which maycomprise a suitable metal or other preferably conductive material.Conductive core 1260 may comprise a unitary shape that forms thestructure(s) depicted in the drawings, namely, opposing beads 1250,strut 1280, a distal recess through which a lysing segment may extend,as discussed below, and two proximal recesses through which twocorresponding lysing segments may extend. As a finished product, each ofthe surfaces of lysing instrument 1200 other than these lysing segmentsmay be coated, layered, or otherwise configured to avoid deliveringenergy, electrosurgical or otherwise, therefrom. Thus, in someembodiments, lysing tip 1233 may be coated with a suitablenon-conductive material, such as high melting point polymers, ceramics,and/or glass. Examples of ceramic coatings may include those fromMetaCeram® that may be tailored for a particular use and employ such rawmaterials as high purity chromium oxides, alumina-zirconia composites,and/or blends of aluminum oxide and titanium oxide. Examples of suitableglass coatings may include Porcelain enamels (frits), “art” glass frits,commercial frits, and frits used in dental applications. Glass coatingmay be employed with application by: dip coating, spray, electrostaticapplication and sifting. Application may be followed by a curing firingto vitrify the glass. In alternative implementations, PVD may also beused, in which case no further vitrification may be required.

In certain implementations of methods of manufacture, conductive core1260 of lysing tip 1233 may be entirely coated with any of theaforementioned materials or another suitable material to form a shell1256 to prevent or at least inhibit transfer of electrosurgical or otherenergy from the conductive core 1260 to adjacent tissue during asurgical procedure. After this coating has been applied, thecoating/shell 1256 may be selectively removed from certain areas, suchas regions within the distal and proximal recesses of instrument 1200defining the desired lysing segments 1260 d and 1260 p, by way ofetching or another suitable process. In other implementations, thedesired lysing segments may be established by masking these regionsbefore the coating/layer(s) is applied to conductive core 1260 so thatno etching/removal of shell 1256 is required.

In some embodiments and implementations, the areas defining the lysingsegments may further be sharpened or otherwise formed with shapesconfigured to facilitate desired delivery of energy therethrough and/ordissect tissue without application of energy. This sharpening may beaccomplished in the same step as etching the non-conductive shell 1256or in an independent step.

In FIG. 12 , conductive unibody form 1233 comprises structural featuressimilar to embodiments previously described herein, however, thesefeatures/elements are preferably indefeasibly coupled as one unitaryformed body. Distal protrusions 1201 d and distal recesses 1202 d may besubstantially defined by a plurality of distal tips 1250 d of beads1250, distal lysing element 1260 d, and/or the front edge of strut 1280.Proximal protrusions 1201 p and recesses 1202 p may be defined byproximal tips 1250 p of beads 1250, proximal lysing elements 1260 p,and/or the back edge of strut 1280. As previously mentioned, conductivedistal lysing segment 1260 d and conductive proximal lysing segments1260 p are exposed to facilitate delivery of energy therethrough.

As depicted in FIGS. 13 a-c , lysing tip 1333 comprises a conductive,unibody core 1360, which may comprise a suitable metal or otherpreferably conductive material. Conductive core 1360 may comprise aunitary shape that forms the structure(s) depicted in the drawings,namely, opposing beads 1350, struts 1380, and shaft extension/nose 1336.Beads 1350 define forward and rearward-facing protrusions and partiallydefine corresponding forward and rearward-facing recesses through whichcorresponding lysing segments may extend, as previously discussed. As afinished product, each of the surfaces of lysing instrument 1300 otherthan these lysing segments (i.e., distal-facing lysing segments 1360 dand proximal-facing lysing segments 1360 p) may be coated, layered, orotherwise configured to avoid delivering energy, electrosurgical orotherwise, therefrom. Thus, in some embodiments, lysing tip 1333 may becoated with a suitable non-conductive material, such as those listed forthe embodiment depicted in FIG. 12 .

As best depicted in FIG. 13 c , in certain implementations of methods ofmanufacture, conductive core 1360 of lysing tip 1333 may be entirelycoated or otherwise applied with any of the aforementioned materials oranother suitable material to form a coating and/or shell 1356 to preventor at least inhibit transfer of electrosurgical or other energy from theconductive core 1360 to adjacent tissue during a surgical procedure.After this coating has been applied, the coating/shell 1356 may beselectively removed from certain areas, such as regions within thedistal and proximal recesses of instrument 1300 defining the desiredlysing segments 1360 d and 1360 p, by way of etching or another suitableprocess. In other implementations, the desired lysing segments may beestablished by masking these regions before the coating/layer(s) isapplied to conductive core 1360 so that no etching/removal of shell 1356is required.

In FIG. 13 a , conductive unibody form 1333 comprises structuralfeatures similar to embodiments previously described herein, however,these features/elements are preferably indefeasibly coupled as oneunitary formed body. Distal protrusions 1301 d and distal recesses 1302d may be substantially defined by a plurality of distal tips 1350 d ofbeads 1350, distal lysing segments 1360 d, and/or the front edges ofstrut 1380. Proximal protrusions 1301 p and recesses 1302 p may bedefined by proximal tips 1350 p of beads 1350, proximal lysing elements1360 p, and/or the back edge of strut 1380. As previously mentioned,conductive distal lysing segment 1360 d and conductive proximal lysingsegments 1360 p are exposed to facilitate delivery of energytherethrough.

These coating/etching/shell principles may be applied to any of theother embodiments disclosed herein, or to other embodiments available tothose of ordinary skill in the art after having received the benefit ofthis disclosure, such as embodiments having different numbers of beads,distal protrusions, distal recesses and/or lysing segments, proximalprotrusions, and/or proximal recesses and/or lysing segments.

In some embodiments, such as that depicted in FIGS. 14 a-d , the lysingtip 1433 of a lysing tip system similar to those already disclosedherein may have the angle of attack of its cutting surfaces modifiedwith a means for pressing a portion of a control instrument and/orlysing tip against a tissue to direct the lysing tip towards a desiredtreatment tissue in a direction normal or at least substantially normalto an axis of the control instrument, such as deflection system 1400.Deflection system 1400 may be used for pressing a portion of a controlinstrument and/or lysing tip against a tissue to direct the lysing tiptowards a desired treatment tissue, such as in the depicted embodimentin a direction normal or at least substantially normal to an axis of thecontrol instrument. In other embodiments, it is contemplated thatdeflection system 1400 may be configured to deflect or otherwise movethe lysing tip away from or towards a particular tissue and/or treatmentarea without necessarily doing so in a direction normal to the axis ofthe instrument. Longer cannulas may tend to be less controllable fortreatment zones that are distant from the entrance wound. Thus, one ormore deflection legs 1490L or other suitable deflection means may beuseful, especially in cosmetic procedures, such as cellulite treatment,in order to force the lysing tip 1433 more superficially against thelower dermis, for example. The presence of the deployed deflection legs1490L may facilitate surgery in more distal locations from the entrancewound. In the depicted embodiment, four bow-like, segments, deflectionlegs 1490L may be present on the distal to mid-distal portions of thedevice shaft and be deployable individually or as a group.

More specifically, deflection legs 1490L may be part of a deflectionsleeve 1490, which may comprise one or more slidable deployment members1490 a, each of which may be coupled to one or more deflection legs1490L. In the depicted embodiment, an upper deployment member 1490 a iscoupled to two upper deflection legs 1490L and a lower deployment member1490 a is coupled to two lower deflection legs 1490L. In this manner, asurgical instrument used with deflection system 1400 may be configuredfor being deflected in either direction (or, in other embodiments, anynumber of more precise directions according to the number of deflectionlegs 1490L and/or deployment members 1490 a) depending upon which of thedeployment members 1490 a is actuated. Thus, as shown in FIG. 14 d ,upon advancement of the upper deployment member 1490 a, which in thedepicted embodiment defines a cylindrical surface configured to extendover (or inside of) a similarly-shaped instrument shaft, the upper twodeflection legs 1490L bow outward in order to provide a deflectionforce, as described above.

In the depicted embodiment, it will be assumed that base lysing deviceis similar to one previously disclosed (e.g., 1090 and 1190) wherein alysing tip 1433 is supported and driven by proximal shaft that leads toan energy supply. Deflection system 1400 comprises outer sheath 1495,which may comprise slots 1495 s configured to allow deflection legs1490L to extend/bow therethrough, and deflector sleeve 1490. Deflectorsleeve 1490 may comprise collar 1490 c, deflector legs 1490L, anddeployment member(s) 1490 a, which may comprise holes 1490 h that may becoupled with a suitable handle and/or control for separately actuatingeach of the various deployment members 1490 a. Collar 1490 c effectivelycouples the deflector sleeve 1490 to the device shaft. Again, deploymentmembers 1490 a each couple to a separate leg 1490L and when pusheddistally or pulled proximally the proper distance, deploy or retract theleg 1490L to which it is coupled, respectively. Outer sheath 1495comprises slits 1495 s through which the deflector legs 1490L may alsohold deployment members 1490 a in place for operation.

Deflection legs 1490L may vary in number as desired in accordance withpreferred functionality, such as from 1 to 10 on a given assembly.Deflection legs 1490L may be comprised of silicone, rubber, plastic,halogenated hydrocarbon, silastic, nylon, vinyl, polycarbonate, and thelike. Deflection legs 1490L may also be comprised of stainless steel, inpreferred embodiments approximately 0.1 mm thick. In some embodiments,the shape of deflection legs 1490L may comprise a slightly bent shape inthe relaxed state so that when manipulated with a compression force toextend the legs, the relaxed shape will permit efficient extension. Inother embodiments, the shape of the deflection legs 1490L may be fullyextended in the relaxed state and may be retracted with a withdrawalforce from deployment members 1490 a.

FIGS. 15 a-15 d depict an embodiment of a bipolar lysing instrument1500. Instrument 1500 may comprise shaft 1590 and two-way lysing tip1533. Lysing tip 1533 is configured for two-way motion (i.e.,forward/distal and reverse/proximal motion) due to, as discussed above,the presence of lysing segments that face in the forward/distaldirection to facilitate forward motion of lysing tip 1533 through tissueand other lysing segments that face in the rearward/proximal directionto facilitate rearward/proximal motion of lysing tip 1533 throughtissue.

In contrast to the previous similar embodiments that may be monopolar,instrument 1500 is bipolar and is comprised of two isolated electrodes,each of opposite and alternating polarity, namely, electrodes 1560 p and1560 n. Electrodes 1560 p and 1560 n may define distal lysing segments1560 pd and 1560 nd, respectively, and may define proximal lysingsegments 1560 pp and 1560 np, respectively. Shaft 1590 may physicallycouple lysing tip 1533 to an electrosurgical energy source via proximalshafts of electrodes 1560 p and 1560 n, respectively, which, in thedepicted embodiment comprises a conductive rod, which may beelectrically conductive and act as a conduit for electrosurgical energyto flow to/from lysing tip 1533. In the depicted embodiment, proximalshafts of electrodes 1560 p and 1560 n comprise an integral extensionfrom their corresponding electrode portions that extend into or areotherwise coupled with beads 1501. Of course, in alternativeembodiments, wires 1561 p and 1561 n, or another suitable means forelectrical coupling, may instead extend all the way to the portions oftheir corresponding electrodes that are within lysing lip 1533.

The rearward/proximal lysing segments of instrument 1500 extend, asshown in the figures, at least substantially perpendicular to the shaft1590 of instrument 1500 as previously described in connection with FIGS.11 a -11 e.

Lysing tip 1533 comprises one or more distal-facing lysing segments andone or more proximal-facing lysing segments. The lysing segments, bothproximal and distal-facing, on one side of lysing tip 1533 may bedefined by a single electrode or each by its own respective electrode.Thus, in the depicted embodiment, a single positive electrode 1560 p isused to define the distal-facing lysing segment 1560 pd and theproximal-facing lysing segment 1560 pp on the right half of lysing tip1533. Similarly, a single negative electrode 1560 n is used to definethe distal-facing lysing segment 1560 nd and the proximal-facing lysingsegment 1560 np on the left half of lysing tip 1533. Again, separatepositive and negative electrodes may be used to separately define thedistal and proximal facing lysing segments instead if desired.

A non-conductive body 1533 b may be used to define various beads,protrusions, and/or other features that define recesses into which thelysing segments are positioned and/or extend. In some embodiments, therecesses may be defined by beads, struts, and/or lysing segments, aspreviously described. Non-conductive body 1533 b defines threeforward-facing distal protrusions 1501 d defined by the distal tips 1551d of beads 1551 and nose 1536 of shaft 1590 and/or partly by distalrecesses 1502 d (more than two distal recesses may be provided in otherembodiments) positioned between distal tips of beads 1551 d and nose1536. Non-conductive body 1533 b defines three rearward-facing proximalprotrusions 1501 p defined by the proximal tips of beads 1551 and shaft1590 and/or partly by proximal recesses 1502 p (more than two distalrecesses may be provided in other embodiments) positioned between distaltips of beads 1551 d and nose 1536.

Lysing tip 1533 and/or shaft 1590 may further comprise an insulatingbarrier 1554, which may be positioned in between positive electrode(s)1560 p and negative electrode(s) 1560 n so as to keep these electrodeselectrically isolated, or at least substantially electrically isolated,from each other. Insulating barrier 1554 preferably comprises a suitableelectrically non-conductive material, such as an electricallynonconductive polymer, preferably with relatively high meltingtemperature, such as greater than about 300 degrees F. In someembodiments, the nonconductive polymer may comprise for example,polytetrafluoroethylene, polyether etherketone, polysulfone, or thelike. In other contemplated embodiments, this material may comprise anelectrically nonconductive and/or thermally nonconductive polymer. Instill other embodiments, a ceramic material may be used to serve as aninsulating barrier. For example, in some embodiments, insulting barrier1554 may comprise a part (in some such embodiments, an integral part) ofthe non-conductive body 1533 b.

Although a nose 1536 is present in the depicted embodiment, an exampleof which was also discussed and depicted previously, it should beunderstood that, in other embodiments, barrier 1554 may extend all theway to the tip of the center portion of lysing tip 1533, which in thedepicted embodiment comprises nose 1536.

Shaped nonconductive body 1533 b may comprise one or more beads 1551that may be supported by and/or spaced by one or more rigid orsubstantially rigid struts 1580, each of which may be permanently ortemporarily coupled between adjacent beads 1551 and/or between an outerbead and the nose 1536 and/or shaft 1590 or shaft portion of lysing tip1533. In some embodiments, struts 1580 may be further coupled along aproximal region with the shaft of lysing tip 1533. In the preferredembodiment shown in FIGS. 15 a-15 d , shaped nonconductive body 1533 bmay comprise one or more slots that may extend along each strut 1580 toallow for exposure and/or positioning of electrodes/lysing segmentstherein. As previously mentioned, in some embodiments, slot(s) 1580 smay define a distal slot opening defined on its upper and lower sides bystruts 1580 and/or nose 1536 and on its left and right sides by one ormore beads 1551.

In this embodiment, electrodes 1560 p and 1560 n may be passed through adistal slot opening formed in nose 1536 and/or struts 1580 andpositioned and configured to define respective positive and negativedistal lysing segments 1560 nd, which may be defined by exposed portionsof electrodes 1560 p and 1560 n on either side of nose 1536, to facedistally through slots 1580 s and allow for delivery of electrosurgicalenergy, or another type of suitable energy, for modification of tissue,therethrough. Shaped nonconductive body 1533 b may further comprise oneor more similar proximal slot openings 1580 sp through which proximallysing segments 1560 n/p-p of electrodes 1560 p and 1560 n may beexposed to allow for delivery of electrosurgical energy therethrough andto facilitate rearward/proximal movement of lysing tip 1533 throughtissue, as previously explained in greater detail.

In some embodiments the nose 1536 defining the center protrusion may bemanufactured to receive a nose insert 1536 therein, which may be coupledin place via a coupling agent such as a ceramic glue, fastener, or thelike.

Beads 1551, nose 1536, and/or strut 1580 may be comprised of ceramic,cermet, glass, various halogenated hydrocarbons, and any other suitablenonconductors.

As previously mentioned, in some embodiments, beads 1551 may compriseslots, holes, or tunnels for partially receiving electrodes 1560 p and1560 n therein. In other embodiments, beads 1551 may not comprise anytunnels or holes, as also previously mentioned.

When an electrosurgical generator is activated by a surgeon,electrosurgical energy may be transmitted through wires 1561 p and 1561n, or another suitable conductive member, to electrodes 1560 p and 1560n, which activates lysing segments 1560 d and 1560 p for delivery ofbipolar electrosurgical energy into tissue.

In some embodiments, the width of the distal portion of lysing tip 1533(defined between the outermost portions of the outermost beads 1551) maybe between about 6 mm and about 12 mm and the length of the beads, whichmay be defined by the shaped nonconductive body 1533 b, may be betweenabout 3 and about 10 mm.

Retrograde dissection may also facilitate use of alternative tissuetension force vectors adjacent to the target tissues and/or targettissue planes. Tissue tension force vectors may be applied by surgicalassistants and/or the surgeon's non-instrument hand. As well, retrogradedissection may allow for alternative dissection angles.

While the device is energized with electrosurgical energy, beads 1551,nose 1536, and strut 1580 are preferably non-conductive in order toperform the blunt dissection function. However, in some embodiments, oneor more of these elements may comprise a conductive core and anon-conductive coating or shell.

In some embodiments, electrodes 1560 p and/or 1506 n may comprise arigid or at least substantially rigid plate, as shown in FIG. 15 c . Insome such embodiments, electrodes 1560 p and/or 1560 n may comprise asingle, unitary piece of a suitable conductive material that serves eachof the aforementioned functions. Slots 1580 s and/or tunnels in beads1551 may be configured so as to tightly receive the respectiveelectrodes therein so as to prevent or at least inhibit movement orunwanted RF energy escape. As previously mentioned, lysing tip 1533 maycomprise a plurality of beads 1551 and a plurality of recessed lyingsegments that, again, may be defined by one or more electrodes. Itshould be noted that in the embodiments of FIGS. 15 a-15 d , beads 1551are supported laterally along their respective inner sides by struts1580. It should also be noted that beads 1551 lack a base, such as base105 for system 100 detailed in U.S. patent application Ser. No.15/464,199 titled “Apparatus, Systems and Methods for Minimally InvasiveDissection of Tissues” filed on Mar. 20, 2017, which application ishereby incorporated by reference in its entirety. Thus, it should alsobe understood that beads 1551 lack structure immediately behind thebeads, or along the rear ends of beads 1551, for support. It should alsobe noted that lysing tip 1533 comprises beads 1551 that have opposingtips that project both distally and proximally relative to struts 1580.

Shaft 1590 may couple with tip 1533 to facilitate transfer ofelectrosurgical energy in a desired manner and/or allow for manualdissection in the absence of electrosurgical energy. Shaft 1590 or shaftof tip 1533 may be deformable, that is, it may be bent so as to anglethe lysing tip in a desired direction, for example, to ensure the lysingtip is angled up by 3 to 10 degrees so as to direct cutting/lysingtowards the skin in a cosmetic procedure.

While lysing tip 1533 is energized with electrosurgical energy, beads1551 and strut 1580, or at least a portion thereof (such as surfacesother than those exposed for defining/exposing lysing segments), arepreferably non-conductive, thus minimizing unwanted electricaldischarge. The electrically conductive electrode 1560 may be configuredto deliver electrosurgical energy through the various distal and/orproximal lysing segments, as previously mentioned.

Beads 1551, nose 1536, and strut 1580 may therefore be comprised ofceramic, cermet, glass, various halogenated hydrocarbons, and any othersuitable nonconductors. Beads 1551 may be restricted in their motionand/or affixed to struts 1580 via direct coupling (i.e.,continuous/integral ceramic) and/or conductive materials such as thosethat make up electrodes 1560 p and 1560 n. Other sealing methods, suchas epoxy or ceramic glues or potting mixes and the like may be used toseal any unwanted seams or openings to maintain non-conductive integrityin the desired locations. When an electrosurgical generator is activatedby a surgeon, electrosurgical energy may be transmitted through anysuitable electrical coupling elements to electrode 1560.

As previously mentioned, two or more sets of electrodes of bipolarinstrument 1500 may be of opposite polarity and electrically isolatedfrom each other along their paths. This may require that the entirehousing and core components of the instrument be made of a ceramic orother non-conductor with perhaps the use of wire leads that would beelectrically isolated from each other and separately coupled torespective electrodes or electrode sets.

FIGS. 16 a-f depict a TMT system 1600 comprising a tissue modificationtip (TMT) 1610 that may couple to main shaft 1690 that may connect to apower source, such as an electrosurgical energy source. TMT 1610 maycomprise nonconductive housing 1633 and one or more tissue modificationarms 1611. Tissue modification arm 1611 may be configured to bepositioned/deployed in various positions relative to nonconductivehousing 1633. For example, FIG. 16 c depicts a deployedposition/configuration, FIGS. 16 d and 16 e depict a retractedposition/configuration, and an intermediate position is depicted in FIG.16 b . Once deployed, tissue modification arm 1611 may be rotated to atreatment configuration, as generally depicted in the exploded view ofFIG. 16 f.

Modification arm 1611 may comprise nonconductive arm body 1611 b, withinwhich one or more electrodes may be positioned. For example, in someembodiments, a single electrode may be positioned within nonconductivebody 1611 b, which electrode (or, in other embodiments, a plurality ofelectrodes) may define one or more electrode termini 1664, which terminimay protrude from and/or be exposed by openings formed in nonconductivebody 1611 b. In some embodiments, a nonconductive mound 1611 m may bepositioned about these openings for exposure of electrode termini 1664.

Modification arm 1611 may further comprise guide member 1612, which mayserve to fix the position of arm 1611 b relative to housing 1633 in adeployed position. Guide member 1612 may comprise a protrusion from body1611 b and may further comprise a flattened surface on one side that maybe configured to slide against the outer surface of housing 1633adjacent to slide slot 1614. In this manner, guide member 1612, incombination with slide slot 1614, may be configured to preventrotation/pivoting of arm 1613, or at least inhibit such rotation beyonda predetermined range.

Housing 1633 comprises axial shaft-slot 1615 and lateral slide-slot1614. Shaft-slot 1615 may run the length of housing 1633, or at least asuitable length along the distal end of housing 1633, thereby permittingpositioning arm 1613 to pass through by advancing arm 1613 axially andmay further be configured to facilitate coupling of one or moreelectrodes defining electrode termini 1664 with an energy conduit and/orsource proximal to TMT 1610. Positioning arm 1613 may further compriseknob 1613 a, which may be positioned and configured to pivotably couplewith an opening 1611 h formed in modification arm 1611. Preferably, thiscoupling also provides an electrical or other energy coupling thatallows for delivery of electrosurgical energy or other energy toelectrode termini 1614.

During use, a surgeon may use digital manipulation to rotate arm 1611after it has been advanced axially through slot 1615. Slide-slot 1614may then serve as a guide to position and reversibly fix modificationarm 1611 during its deployment and, in some embodiments, at intermediatepositions. During a reverse/retraction motion by a surgeon, arm 1613 mayretract and contact the proximal portion of slot 1614, which may serveto pivot arm 1611 to turn its tip more axially and ultimately withsufficient force, return arm 1613 to its axial configuration. However,by the interaction of the outer portions of slide-slot 1614 and guide1612, modification arm 1611 may remain relatively fixed, or at leastfixed within a particular desired range of motion, during a backstrokeof the instrument.

In alternative embodiments, termini 1664 may be configured to bepositioned on the bottom of arm 1611, either in addition to or as analternative to the position of termini 1664 depicted in the figures.However, in various implementations, a surgeon may simply invert the tipof a top-mounted set of termini 1664 so that the termini point in theopposite direction (for example, away from the surface skin and towardthe subcutaneous tissues). This inward/subcutaneous direction of energymay be useful in directing energy toward the subcutaneous deposits incellulite and other cosmetic and surgically modifiable conditions.

Electrode termini may receive energy from an energy source via conduits(not shown) that may comprise, for example, wires and/or fiber opticfilaments and/or the like. Termini 1664 may be configured in any mannerto accommodate any energy modality, including, but not limited to,laser, intense pulse light, resistive heating, radiant heat,thermochromic, ultrasound, mechanical, and/or microwave.

FIGS. 17 a-17 e depict yet another embodiment of a lysing instrument1700 comprising a lysing tip 1733 having a plurality of beads 1751 and aplurality of lysing segments. Although only distal lysing segments aredepicted in the accompanying drawings, it should be understood thatalternative embodiments are contemplated in which proximal/rearwardlysing segments may also, or alternatively to the distal lysingsegments, be included. The lysing segments may be defined by twoelectrodes, namely, a first electrode 1760 a that extends through alumen or other opening formed in shaft 1790 and bends to the right sideof the instrument 1700 (from the perspective of the surgeon) and asecond electrode 1760 b that extends through a lumen or other opening(could be the same or a different lumen/opening as the first electrode)formed in shaft 1790 and bends to the left side of the instrument 1700.Thus, one electrode 1760 forms two lysing segments on the right side oflysing tip 1733 (one between a first outermost bead and an adjacent beadand another between the adjacent bead and the nose/tip 1701 n of thelysing tip and/or shaft 1790) and another electrode forms another twolysing segments on the opposite side of the device. However, it shouldbe understood that, in other contemplated embodiments, a singleelectrode may form each of the four lysing segments of lysing tip 1733or, alternatively, four separate electrodes may be used to form each ofthe four lysing segments.

Lysing tip 1733 may further comprise one or more struts for separatingthe beads and/or facilitating definition and/or exposure of the variouslysing segments. For example, in the depicted embodiment, strut 1780extends through openings and/or holes formed in each of the variousbeads to provide spacing between the beads and define recesses betweenadjacent beads and/or bead-like structures, such as the distal nose/tip1701 n. Of course, separate struts may be used to define these featuresand/or provide this spacing if desired. Strut(s) 1780 may comprise anelongated slot along its distal edge and/or surface to as to allow forexposure of one or more electrodes 1760 a/b therein so as to definelysing segments along the distal portion of lysing tip 1733.Electrode(s) 1760 a/b may protrude from this slot or may be recessedwithin the slot, depending upon the desired lysing characteristics ofthe device and the type of energy used. As previously mentioned, inother embodiments, a similar slot may be formed along the rear portionof the strut(s) 1780 so as to provide for rearward lysing if desired.

In the embodiment of FIGS. 17 d and 17 e , one or more of the beads 1751a may further comprise spacing 1751 ao, which may be provided byincreasing the diameter of the opening/tunnel through which electrode(s)1760 and/or strut(s) 1780 extend or, in other embodiments, by forminghollow regions and/or cutouts adjacent to the lysing segments and/orstruts. This added spacing may provide one or more desired functions,such as allowing the electrode(s) 1760 a/b to cool. Such spacing mayalso accommodate/facilitate cleaning of the device, provide more cuttingefficiency, assist in determining whether the device has been usedpreviously, particularly for devices intended for single use, may allowfor electrical discharge to take place within the hollow area/spacing,and/or may provide for greater cutting and/or electrosurgical dischargesurface area.

However, as shown in FIG. 17 a , this spacing may be omitted in otherembodiments and the opening/tunnel for receiving the strut(s) and/orelectrode(s) may be relatively tight so as to not accommodate anyappreciable spacing adjacent thereto.

As best shown in FIGS. 17 a and 17 d , beads 1751/1751 a may be somewhatflattened, which may provide sufficient rigidity while still exposingthe lysing segments to sufficient tissue as the device passes by. Thisshape of bead may further facilitate guidance of the beads throughtissue.

In other embodiments, the basic shape of FIG. 17 a-d may be formed withall of its components/features as one unibody piece from a suitableconductive material to which an outer shell of relatively non-conductivematerial is added to prevent energy discharge except for where thelysing segments are exposed by the removal of the outer shell. Thisconcept is similar to that depicted and described in FIGS. 12 and 13a-c.

FIGS. 18 a and 18 b depict an alternative embodiment of a lysing tip1833 of a lysing instrument. In this embodiment, the rear portion of thelysing tip 1833 comprises rearward-facing lysing segments 1860 r thatare configured to facilitate backwards/proximal motion of the lysing tip1833 through tissue. However, unlike the embodiments depicted inprevious figures, lysing tip 1833 comprises rearward-facing lysingsegments 1860 r that are not positioned within and/or extended fromrecesses formed along the rear portion of the lysing tip 1833. Lysingsegments 1860 r may be slightly recessed within slits formed along therear surface of lysing tip 1833 or, alternatively, may protrude slightlyfrom such slits or other suitable openings formed in the non-conductivebody of the lysing tip 1833.

Although this embodiment may be less preferred for certain applications,due to the lack of recesses along the rear portion, which, maycontribute to the efficacy of the maneuverability or other desiredaspects of the functionality of the lysing tip during proximal movementthrough tissue, it may be suitable for certain applications.

The front portion of lysing tip 1833 may be similar to the embodimentspreviously discussed. For example, lysing segments 1860 f, which, again,may be defined by individual electrodes or a single electrode positionedwithin the body of the device, are positioned within concave recessesdefined by adjacent protrusions 1801 d along the front of lysing tip1833. Lysing tip 1833 may be coupled and/or integrated with a lysinginstrument in any suitable manner, including those discussed inconnection with other embodiments disclosed herein.

FIGS. 19 a and 19 b depict yet another alternative embodiment of alysing tip 1933. In this embodiment, the basic shape of the lysing tip1933 is reversed relative to lysing tip 1833. In other words, the front,distal-facing portion of the lysing tip 1933 lacks recesses but,instead, provides lysing segments 1960 f that extend along two portionsof a relatively flat front surface of the lysing tip 1933. As withlysing tip 1833, lysing tip 1933 may comprise lysing segments 1960 fthat either protrude slightly from or are recessed within slits or otheropenings formed in the non-conductive body of lysing tip 1933.

Along the rear portion of lysing tip 1933, similar lysing segments 1960r may be formed that may sit within concave recesses formed by adjacentprotrusions extending proximally from lysing lip 1933.

Yet another embodiment of a lysing tip 2033 is depicted in FIGS. 20 aand 20 b . This embodiment essentially combines the rear portion oflysing tip 1833 with the front portion of lysing tip 1933. In otherwords, lysing tip 2033 lacks any recesses defined by adjacentprotrusions and instead comprises two sets of lysing segments thatextend from or are slightly recessed within relatively flat front (20600and rear (2060 r) surfaces of lysing tip 2033 along the front and rearportions, respectively. Thus, lysing tip 2033 may be configured toprovide for forward and rearward motion in essentially the same manner.By contrast, lysing tips 1833 and 1933 may provide a differentialbetween the feel and/or maneuverability of the tip in the proximal vs.distal directions. Although this differential may be preferable forcertain procedures, a surgeon may prefer to avoid having such adifferential, in which case either the non-recessed embodiment of FIGS.20 a and 20 b or the embodiments having concave recessed formed alongboth the front and the rear of the lysing tip, as previously discussedand described, may be preferred.

FIGS. 21 a-21 c depict a 3-bead oscillating lysing instrument 2100.Instrument 2100 comprises a lysing tip 2133 and main shaft 2190. Lysingtip 2133 comprises a shaped body, which may be comprised of a suitabledurable material designed to withstand strong vibrational forces, forexample, titanium and/or a suitable alloy thereof. Tip body 2133 b maycomprise a unitary shape that forms the structure depicted in thedrawings, namely, opposing beads 2150, struts 2180, and two distalrecesses and two proximal recesses which each correspond to a lysingand/or cutting segment, as previously described. As a finished product,one or more surfaces of lysing instrument 2100 may be coated. In someembodiments, instrument 2100 may be configured to lyse without use ofelectrosurgical energy and therefore the coating applied to lysing tip2133 may comprise a conductive or non-conductive material.

Oscillating lysing tip 2133 comprises structural features similar toembodiments previously described herein, however, thesefeatures/elements are preferably indefeasibly coupled as one unitaryformed body. Distal protrusions 2101 d and distal recesses 2102 d may besubstantially defined by a plurality of distal tips 2150 d of beads2150, extension/nose 2136, distal lysing element 2161 d, and/or thefront edge of strut 2180. Proximal protrusions 2101 p and recesses 2102p may be defined by proximal tips 2150 p of beads 2150, extension/nose2136, proximal lysing elements 2161 p, and/or the back edge of strut2180. Distal lysing segments 2161 d and proximal lysing segments 2161 pmay be sharpened along the edge to facilitate mechanicalcutting/dissection.

Oscillating means 2199 may be located along the shaft at a resonantpoint that vibrates tip 2133 as specified. The power source to driveoscillating means 2199 is readily known to those skilled in the art. Insome embodiments, oscillating means 2199 may operate in the range fromabout 23 to about 40 kHz. Oscillating means 2199 may comprise hard typepiezoceramics as such may have higher Q factors, better linearity, andare harder to depolarize. An example of such ceramic is Navy Type IIImaterial, for example, APC 880 from American Piezoceramics, Mackeyville,PA.

The embodiments depicted in FIGS. 21 a-c may provide surgeons uniquelysing capabilities in certain procedures, for example, cellulite andface/neck tightening procedures.

In some embodiments, a fluid may be distributed at or within one, someor all of the recessions 2102 d/2102 p via tubes 2194 j that may besupplied fluid by fluid channel 2194. Supply of a fluid to the cuttingsite may reduce eschar and reduce heat.

In some embodiments, a skin protection means that reduces friction atthe entrance incision may be disposed around the wound entrancelocation. Such means may be made from a rigid, low friction plastic suchas Teflon or HDPE, in a hollow shaft form, surrounding the main drivingelement.

The invention claimed is:
 1. An electrosurgical lysing device,comprising: a lysing tip, comprising: at least one bead comprising an atleast substantially electrically non-conductive surface; and at leastone lysing member defining at least one lysing segment extending withina recess defined, at least in part, by the at least one bead, whereinthe at least one bead protrudes both distally and proximally relative tothe at least one lysing member.
 2. The electrosurgical lysing device ofclaim 1, further comprising at least one structure positioned adjacentto the at least one bead, the at least one structure comprising an atleast substantially electrically non-conductive surface and at leastpartially defining the recess.
 3. The electrosurgical lysing device ofclaim 2, wherein the at least one structure comprises a bead comprisingan at least substantially electrically non-conductive surface.
 4. Theelectrosurgical lysing device of claim 2, wherein the at least onestructure comprises a portion of a shaft of the electrosurgical lysingdevice.
 5. The electrosurgical lysing device of claim 4, wherein the atleast one structure comprises a portion of a distal tip of the shaft. 6.The electrosurgical lysing device of claim 2, further comprising acontrol instrument, wherein the at least one structure comprises aportion of the control instrument.
 7. The electrosurgical lysing deviceof claim 6, wherein the lysing tip is configured to be coupled with andcontrolled by the control instrument.
 8. The electrosurgical lysingdevice of claim 7, wherein the at least one structure comprises aportion of a shaft of the control instrument.
 9. The electrosurgicallysing device of claim 1, further comprising a shaft fixedly coupledwith the lysing tip.
 10. The electrosurgical lysing device of claim 9,wherein the shaft is integrally coupled with the lysing tip.
 11. Theelectrosurgical lysing device of claim 9, wherein the at least one beadcomprises a first bead positioned at a first end of the lysing tip and asecond bead positioned at a second end of the lysing tip opposite thefirst end, and wherein both the first bead and the second bead protrudeboth distally and proximally relative to the at least one lysing member.12. The electrosurgical lysing device of claim 9, wherein a distal tipof the shaft at least partially defines the recess.
 13. Theelectrosurgical lysing device of claim 12, wherein the distal tip of theshaft at least partially defines a second recess, and wherein a lysingsegment is positioned within the second recess.
 14. The electrosurgicallysing device of claim 1, wherein the at least one bead comprises aproximal inner surface terminating at a pointed proximal tip.
 15. Theelectrosurgical lysing device of claim 1, wherein the at least onelysing member comprises a lysing plate.
 16. The electrosurgical lysingdevice of claim 15, wherein the lysing plate defines at least twoseparate lysing segments.
 17. The electrosurgical lysing device of claim16, wherein the lysing plate defines at least one distal lysing segmentand at least one proximal lysing segment.
 18. The electrosurgical lysingdevice of claim 17, wherein the lysing plate defines at least two distallysing segments and at least one proximal lysing segment.
 19. Anelectrosurgical lysing device, comprising: at least one bead comprisingan at least substantially electrically non-conductive surface; at leastone structure positioned adjacent to the at least one bead, the at leastone structure comprising an at least substantially electricallynon-conductive surface; and at least one electrically conductive lysingmember defining at least one lysing segment extending within a recessdefined, at least in part, by the at least one bead and by the at leastone structure, wherein the at least one bead protrudes both distally andproximally relative to the at least one lysing member.
 20. Theelectrosurgical lysing device of claim 19, wherein the at least onestructure comprises a bead comprising an at least substantiallyelectrically non-conductive surface.
 21. The electrosurgical lysingdevice of claim 19, wherein the at least one structure comprises adistal tip of a shaft, and wherein the distal tip comprises an at leastsubstantially electrically non-conductive surface.
 22. Theelectrosurgical lysing device of claim 21, wherein the at least one beadis part of a lysing tip.
 23. The electrosurgical lysing device of claim19, further comprising a control instrument, wherein the at least onestructure comprises a portion of the control instrument.
 24. Theelectrosurgical lysing device of claim 23, wherein the at least one beadis part of a lysing tip, and wherein the lysing tip is configured to becoupled with and controlled by the control instrument.
 25. Theelectrosurgical lysing device of claim 23, wherein the at least onestructure comprises a portion of a shaft of the control instrument. 26.The electrosurgical lysing device of claim 19, further comprising ashaft fixedly coupled with a lysing tip, wherein the lysing tipcomprises the at least one bead.
 27. The electrosurgical lysing deviceof claim 26, wherein the shaft integrally extends from the lysing tip.